Provider Demographics
NPI:1770585465
Name:MONTPELIER PHARMACY INC
Entity type:Organization
Organization Name:MONTPELIER PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:W
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-883-6363
Mailing Address - Street 1:17128 MOUNTAIN RD
Mailing Address - Street 2:PO BOX 5
Mailing Address - City:MONTPELIER
Mailing Address - State:VA
Mailing Address - Zip Code:23192-0005
Mailing Address - Country:US
Mailing Address - Phone:804-883-6363
Mailing Address - Fax:804-883-5788
Practice Address - Street 1:17128 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VA
Practice Address - Zip Code:23192-2550
Practice Address - Country:US
Practice Address - Phone:804-883-6363
Practice Address - Fax:804-883-5788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201002247333600000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVA008500011Medicaid
VAVA009115951Medicaid
4807232OtherNABP
4807232OtherNABP
0427950001Medicare NSC