Provider Demographics
NPI:1780303032
Name:WILLIAMSBURG DRUG CO., INC
Entity type:Organization
Organization Name:WILLIAMSBURG DRUG CO., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:757-229-1041
Mailing Address - Street 1:1310 JAMESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3309
Mailing Address - Country:US
Mailing Address - Phone:757-229-3560
Mailing Address - Fax:757-253-5651
Practice Address - Street 1:240 MCLAWS CIR STE 147
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-6429
Practice Address - Country:US
Practice Address - Phone:757-229-1041
Practice Address - Fax:757-229-3780
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLIAMSBURG DRUG CO., INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA114721920Medicaid