Provider Demographics
NPI:1255348363
Name:SCOTTIE PHARMACY INC
Entity type:Organization
Organization Name:SCOTTIE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSLOW
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:276-963-0284
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-0337
Mailing Address - Country:US
Mailing Address - Phone:276-963-0284
Mailing Address - Fax:276-963-4465
Practice Address - Street 1:1951 2ND ST
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-2303
Practice Address - Country:US
Practice Address - Phone:276-963-0284
Practice Address - Fax:276-963-4465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201003542333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008520101Medicaid
WV6005012000Medicaid
VA008517541Medicaid