Provider Demographics
NPI:1184728156
Name:O & B PHARMACY INC
Entity type:Organization
Organization Name:O & B PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:CHIP
Authorized Official - Middle Name:
Authorized Official - Last Name:BUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-527-1927
Mailing Address - Street 1:8903 THREE CHOPT RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4614
Mailing Address - Country:US
Mailing Address - Phone:804-285-3428
Mailing Address - Fax:804-285-3617
Practice Address - Street 1:8903 THREE CHOPT RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23229-4614
Practice Address - Country:US
Practice Address - Phone:804-285-3428
Practice Address - Fax:804-285-3617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010030123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2105888OtherPK
VA8011326491Medicaid