Provider Demographics
NPI:1700159696
Name:ELKTON HEALTHCARE SERVICES INC
Entity Type:Organization
Organization Name:ELKTON HEALTHCARE SERVICES INC
Other - Org Name:ELKTON FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT - PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEYMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:540-661-7704
Mailing Address - Street 1:111 S STUART AVE
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22827-1525
Mailing Address - Country:US
Mailing Address - Phone:540-298-9090
Mailing Address - Fax:540-713-6399
Practice Address - Street 1:111 S STUART AVE
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:VA
Practice Address - Zip Code:22827-1525
Practice Address - Country:US
Practice Address - Phone:540-298-9090
Practice Address - Fax:540-713-6399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
VA02010044453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1700159696Medicaid
2133934OtherPK
VA1700159696Medicaid