Provider Demographics
NPI:1366523185
Name:CRITTENDEN'S DRUG STORE
Entity type:Organization
Organization Name:CRITTENDEN'S DRUG STORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:K
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:434-645-9545
Mailing Address - Street 1:121 WEST CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:CREWE
Mailing Address - State:VA
Mailing Address - Zip Code:23930
Mailing Address - Country:US
Mailing Address - Phone:434-645-9545
Mailing Address - Fax:434-645-8183
Practice Address - Street 1:121 WEST CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:CREWE
Practice Address - State:VA
Practice Address - Zip Code:23930
Practice Address - Country:US
Practice Address - Phone:434-645-9545
Practice Address - Fax:434-645-8183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201000136183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8504334Medicaid
4805733OtherOTHER INSURANCES