Provider Demographics
NPI:1669601324
Name:CUMBERLAND PHARMACY INC
Entity type:Organization
Organization Name:CUMBERLAND PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-492-4325
Mailing Address - Street 1:1756 ANDERSON HWY
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23040-2524
Mailing Address - Country:US
Mailing Address - Phone:804-492-4325
Mailing Address - Fax:804-492-9384
Practice Address - Street 1:1756 ANDERSON HWY
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:VA
Practice Address - Zip Code:23040-2524
Practice Address - Country:US
Practice Address - Phone:804-492-4325
Practice Address - Fax:804-492-9384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010025483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2120929OtherPK
VA1669601324Medicaid
VA1669601324Medicaid