Provider Demographics
NPI:1811988827
Name:RADFORD DRUG INC
Entity type:Organization
Organization Name:RADFORD DRUG INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND RPH
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:540-639-3996
Mailing Address - Street 1:243 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-1584
Mailing Address - Country:US
Mailing Address - Phone:540-639-3996
Mailing Address - Fax:540-731-4852
Practice Address - Street 1:243 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-1584
Practice Address - Country:US
Practice Address - Phone:540-639-3996
Practice Address - Fax:540-731-4852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010006813336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008501661Medicaid
2102193OtherPK
VA009148604Medicaid
VA009148604Medicaid
VA009148604Medicaid
VA0265250001Medicare NSC