Provider Demographics
NPI:1891081642
Name:PHAMILY PHARMACY INC
Entity Type:Organization
Organization Name:PHAMILY PHARMACY INC
Other - Org Name:BROSVILLE FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-627-0536
Mailing Address - Street 1:PO BOX 477
Mailing Address - Street 2:
Mailing Address - City:STANLEYTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:24168-0477
Mailing Address - Country:US
Mailing Address - Phone:276-627-0536
Mailing Address - Fax:276-627-6074
Practice Address - Street 1:10372 MARTINSVILLE HWY STE A
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-6888
Practice Address - Country:US
Practice Address - Phone:434-685-1509
Practice Address - Fax:434-685-1512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
VA02010043963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2130773OtherPK