Provider Demographics
NPI:1386087245
Name:ABINGDON APOTHECARY, INC.
Entity type:Organization
Organization Name:ABINGDON APOTHECARY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER/PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:COUNTS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:276-525-4633
Mailing Address - Street 1:26100 LEE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211
Mailing Address - Country:US
Mailing Address - Phone:276-525-4633
Mailing Address - Fax:276-525-4500
Practice Address - Street 1:26100 LEE HIGHWAY
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211
Practice Address - Country:US
Practice Address - Phone:276-525-4633
Practice Address - Fax:276-525-4500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABINGDON APOTHECARY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-10
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02011004509333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4844545OtherNCPDP
VA1386087245Medicaid