Provider Demographics
NPI:1073855094
Name:BATTLETOWN PHARMACY, INC.
Entity type:Organization
Organization Name:BATTLETOWN PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:540-686-5485
Mailing Address - Street 1:33 W MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BERRYVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22611-1340
Mailing Address - Country:US
Mailing Address - Phone:540-955-0500
Mailing Address - Fax:540-955-0515
Practice Address - Street 1:33 W MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:BERRYVILLE
Practice Address - State:VA
Practice Address - Zip Code:22611-1340
Practice Address - Country:US
Practice Address - Phone:540-955-0500
Practice Address - Fax:540-955-0515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-18
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010045393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1073855094Medicaid
VA6939960001OtherMEDICARE PTAN