Provider Demographics
NPI:1316229883
Name:APPALACHIAN COLLEGE OF PHARMACY
Entity type:Organization
Organization Name:APPALACHIAN COLLEGE OF PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEAN
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYHEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-498-5201
Mailing Address - Street 1:8252 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:VA
Mailing Address - Zip Code:24631-8972
Mailing Address - Country:US
Mailing Address - Phone:276-498-5261
Mailing Address - Fax:276-498-5268
Practice Address - Street 1:8252 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:VA
Practice Address - Zip Code:24631-8972
Practice Address - Country:US
Practice Address - Phone:276-498-5261
Practice Address - Fax:276-498-5268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-12
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010044093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4844153OtherNCPDP PROVIDER IDENTIFICATION NUMBER