Provider Demographics
NPI:1023583887
Name:RVA PHARMACY LLC
Entity type:Organization
Organization Name:RVA PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY IN-CHARGE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEHULKUMAR
Authorized Official - Middle Name:MANUBHAI
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:732-485-3748
Mailing Address - Street 1:7801 W BROAD ST STE 19
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-6309
Mailing Address - Country:US
Mailing Address - Phone:804-528-5589
Mailing Address - Fax:
Practice Address - Street 1:7801 W BROAD ST STE 19
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-6309
Practice Address - Country:US
Practice Address - Phone:804-528-5589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0201004860OtherPHARMACY LICENSE NO.