ZZ-FREDERICKSBURG PHARMACY (2816)    INSTITUTION (4)

Name Value
NAME ZZ-FREDERICKSBURG PHARMACY
STATE VIRGINIA
STREET ADDR. 1 1965 JEFFERSON DAVIS HWY
CITY FREDERICKSBURG
ZIP 22401-6213
OFFICIAL VA NAME FREDERICKSBURG PHARMACY
INACTIVE FACILITY FLAG INACTIVE
STATUS National
ASSOCIATIONS
BILLING FACILITY NAME FREDERICKSBURG VA CBOC PHARMACY
ST. ADDR. 1 (MAILING) 1965 JEFFERSON DAVIS HWY
CITY (MAILING) FREDERICKSBURG
STATE (MAILING) VIRGINIA
ZIP (MAILING) 22401-6213
EFFECTIVE DATE/TIME
  • 2006-08-22 00:00:00
    STATUS:   ACTIVE
    NPI:   1336197144
TAXONOMY CODE
  • Suppliers
    PRIMARY CODE:   YES
    STATUS:   ACTIVE
LOCATION TIMEZONE EASTERN
COUNTRY USA
AGENCY CODE VA
POINTER TO AGENCY VA
IDENTIFIER
  • CODING SYSTEM:   NPI
    ID:   1336197144