Provider Demographics
NPI:1215912514
Name:WEST AUGUSTA PHARMACY
Entity type:Organization
Organization Name:WEST AUGUSTA PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:540-337-6175
Mailing Address - Street 1:P O BOX 100
Mailing Address - Street 2:
Mailing Address - City:CRAIGSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24430-0000
Mailing Address - Country:US
Mailing Address - Phone:540-337-6175
Mailing Address - Fax:540-337-6194
Practice Address - Street 1:21 SCENIC HIGHWAY
Practice Address - Street 2:RIVERSIDE PLAZA
Practice Address - City:CHURCHVILLE
Practice Address - State:VA
Practice Address - Zip Code:24421-0000
Practice Address - Country:US
Practice Address - Phone:540-337-6175
Practice Address - Fax:540-337-6194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201001348333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy