Provider Demographics
NPI:1255768040
Name:COMMONWEALTH PHARMACY CHATHAM
Entity type:Organization
Organization Name:COMMONWEALTH PHARMACY CHATHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:RODDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-432-2094
Mailing Address - Street 1:21 S MAIN ST
Mailing Address - Street 2:P.O.BOX 917
Mailing Address - City:CHATHAM
Mailing Address - State:VA
Mailing Address - Zip Code:24531-5536
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:24531-5536
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:2013-10-11
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0222740001Medicare NSC