Provider Demographics
NPI:1184721920
Name:WILLIAMSBURG DRUG CO INC
Entity type:Organization
Organization Name:WILLIAMSBURG DRUG CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-229-1041
Mailing Address - Street 1:240 MCLAWS CIR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5678
Mailing Address - Country:US
Mailing Address - Phone:757-229-1041
Mailing Address - Fax:757-229-7014
Practice Address - Street 1:240 MCLAWS CIR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5678
Practice Address - Country:US
Practice Address - Phone:757-229-1041
Practice Address - Fax:757-229-7014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010016163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2102940OtherPK
VA1184721920Medicaid
1257850002Medicare NSC