Provider Demographics
NPI:1205087483
Name:COMMONWEALTH PHARMACY, INC
Entity type:Organization
Organization Name:COMMONWEALTH PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:800-528-4412
Mailing Address - Street 1:21 S.MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:VA
Mailing Address - Zip Code:24531-3113
Mailing Address - Country:US
Mailing Address - Phone:434-432-2094
Mailing Address - Fax:434-432-2098
Practice Address - Street 1:21 S.MAIN ST.
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:VA
Practice Address - Zip Code:24531-3113
Practice Address - Country:US
Practice Address - Phone:434-432-2094
Practice Address - Fax:434-432-2098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2837332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009136029Medicaid
VA009136029Medicaid