Provider Demographics
NPI:1811639222
Name:FAIR WAY PHARMACY, PLLC
Entity type:Organization
Organization Name:FAIR WAY PHARMACY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PATE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:540-524-9983
Mailing Address - Street 1:2311 SANFORD AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1122
Mailing Address - Country:US
Mailing Address - Phone:540-524-9983
Mailing Address - Fax:
Practice Address - Street 1:2311 SANFORD AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1122
Practice Address - Country:US
Practice Address - Phone:540-524-9983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy