Provider Demographics
NPI:1811988298
Name:JAMESTOWN PHARMACY CARE CENTER
Entity type:Organization
Organization Name:JAMESTOWN PHARMACY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:757-565-7570
Mailing Address - Street 1:1781 JAMESTOWN RD
Mailing Address - Street 2:STE 160
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-2363
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1781 JAMESTOWN RD
Practice Address - Street 2:STE 160
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2363
Practice Address - Country:US
Practice Address - Phone:757-565-7570
Practice Address - Fax:757-565-7573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
VA0201004009333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4838489OtherOTHER ID NUMBER-COMMERCIAL NUMBER