Provider Demographics
NPI:1285621995
Name:WILLIAMSONS RETAIL INC
Entity type:Organization
Organization Name:WILLIAMSONS RETAIL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOWALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-434-2372
Mailing Address - Street 1:1380 LITTLE SORRELL DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-7372
Mailing Address - Country:US
Mailing Address - Phone:540-434-2372
Mailing Address - Fax:540-434-8122
Practice Address - Street 1:1380 LITTLE SORRELL DR STE 110
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-7372
Practice Address - Country:US
Practice Address - Phone:540-434-2372
Practice Address - Fax:540-434-8122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010009023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8515158Medicaid
2102647OtherPK
0239530001Medicare NSC