Provider Demographics
NPI:1770682635
Name:RICHLANDS PHARMACY ASSOCIATES INC
Entity Type:Organization
Organization Name:RICHLANDS PHARMACY ASSOCIATES INC
Other - Org Name:NEW GARDEN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:276-873-6132
Mailing Address - Street 1:PO BOX 742
Mailing Address - Street 2:
Mailing Address - City:HONAKER
Mailing Address - State:VA
Mailing Address - Zip Code:24260-0742
Mailing Address - Country:US
Mailing Address - Phone:276-873-6132
Mailing Address - Fax:276-873-4614
Practice Address - Street 1:4697 REDBUD HWY
Practice Address - Street 2:
Practice Address - City:HONAKER
Practice Address - State:VA
Practice Address - Zip Code:24260
Practice Address - Country:US
Practice Address - Phone:276-873-6132
Practice Address - Fax:276-873-4614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010018883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2102652OtherPK
VA8513431Medicaid
VA8513431Medicaid