Provider Demographics
NPI:1982635900
Name:DAWSON'S PHARMACY, INC.
Entity Type:Organization
Organization Name:DAWSON'S PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VIRGIL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:II
Authorized Official - Credentials:BS
Authorized Official - Phone:804-556-3311
Mailing Address - Street 1:2728 FAIRGROUND RD
Mailing Address - Street 2:
Mailing Address - City:GOOCHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23063-3103
Mailing Address - Country:US
Mailing Address - Phone:804-556-3311
Mailing Address - Fax:804-556-5520
Practice Address - Street 1:2728 FAIRGROUND RD
Practice Address - Street 2:
Practice Address - City:GOOCHLAND
Practice Address - State:VA
Practice Address - Zip Code:23063-3103
Practice Address - Country:US
Practice Address - Phone:804-556-3311
Practice Address - Fax:804-556-5520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010040053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4838403OtherNABP
VA010123747Medicaid
VA010123747Medicaid