Provider Demographics
NPI:1386149326
Name:MIDLOTHIAN COMMUNITY PHARMACY LLC
Entity type:Organization
Organization Name:MIDLOTHIAN COMMUNITY PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHEHZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROOPANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-220-1408
Mailing Address - Street 1:1535 WEST LOOP S
Mailing Address - Street 2:SUITE 410
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-9512
Mailing Address - Country:US
Mailing Address - Phone:804-220-1408
Mailing Address - Fax:888-225-6632
Practice Address - Street 1:9550 MIDLOTHIAN TPKE
Practice Address - Street 2:UNIT 119
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4900
Practice Address - Country:US
Practice Address - Phone:804-220-1408
Practice Address - Fax:888-225-6632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176812OtherPK