Provider Demographics
NPI:1356723274
Name:ROCKBRIDGE PHARMACY LLC
Entity type:Organization
Organization Name:ROCKBRIDGE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAMITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GURUNG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:571-438-3691
Mailing Address - Street 1:146 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-2356
Mailing Address - Country:US
Mailing Address - Phone:540-463-4001
Mailing Address - Fax:540-463-1119
Practice Address - Street 1:146 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-2356
Practice Address - Country:US
Practice Address - Phone:540-463-4001
Practice Address - Fax:540-463-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-27
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010046533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1356723274Medicaid