Provider Demographics
NPI:1477652337
Name:DONALD W RAWLINGS
Entity type:Organization
Organization Name:DONALD W RAWLINGS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER SURRY DRUG G
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:RAWLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:757-294-3607
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:79 COLONIAL TRAIL EAST
Mailing Address - City:SURRY
Mailing Address - State:VA
Mailing Address - Zip Code:23883-0247
Mailing Address - Country:US
Mailing Address - Phone:757-294-3607
Mailing Address - Fax:757-294-0215
Practice Address - Street 1:79 COLONIAL TRAIL EAST
Practice Address - Street 2:
Practice Address - City:SURRY
Practice Address - State:VA
Practice Address - Zip Code:23883-9801
Practice Address - Country:US
Practice Address - Phone:757-294-3607
Practice Address - Fax:757-294-0215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
VA0201000802333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4809969OtherOTHER ID NUMBER-COMMERCIAL NUMBER
VA008501980Medicaid