Provider Demographics
NPI:1770910655
Name:SHAWSVILLE PHARMACY INC
Entity type:Organization
Organization Name:SHAWSVILLE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:FAUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-904-2255
Mailing Address - Street 1:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24002-0301
Mailing Address - Country:US
Mailing Address - Phone:540-904-2255
Mailing Address - Fax:540-904-2685
Practice Address - Street 1:300 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24011-1901
Practice Address - Country:US
Practice Address - Phone:540-904-2255
Practice Address - Fax:540-904-2685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010045623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy