Provider Demographics
NPI:1841236338
Name:GOAD & DAVIS COMPANY INC
Entity Type:Organization
Organization Name:GOAD & DAVIS COMPANY INC
Other - Org Name:STARLING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLER MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:276-632-6222
Mailing Address - Street 1:1312 MEMORIAL BLVD S
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-4809
Mailing Address - Country:US
Mailing Address - Phone:276-632-6222
Mailing Address - Fax:276-632-3294
Practice Address - Street 1:1312 MEMORIAL BLVD S
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-4809
Practice Address - Country:US
Practice Address - Phone:276-632-6222
Practice Address - Fax:276-632-3294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010007743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010264596Medicaid
VA010264618Medicaid
2102685OtherPK
VA010264596Medicaid