Provider Demographics
NPI:1952346322
Name:PARKWAY PHARMACY INC
Entity Type:Organization
Organization Name:PARKWAY PHARMACY INC
Other - Org Name:PARKWAY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PLANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-823-6337
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:CROZET
Mailing Address - State:VA
Mailing Address - Zip Code:22932-0008
Mailing Address - Country:US
Mailing Address - Phone:434-823-6337
Mailing Address - Fax:434-823-1912
Practice Address - Street 1:5771 THE SQ
Practice Address - Street 2:
Practice Address - City:CROZET
Practice Address - State:VA
Practice Address - Zip Code:22932-3182
Practice Address - Country:US
Practice Address - Phone:434-823-6337
Practice Address - Fax:434-823-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010035643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009119973Medicaid
VA008517151Medicaid
2104203OtherPK
VA009119973Medicaid