Provider Demographics
NPI:1386728806
Name:CHARLOTTE DRUG COMPANY
Entity type:Organization
Organization Name:CHARLOTTE DRUG COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:434-542-5171
Mailing Address - Street 1:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE COURT HOUSE
Mailing Address - State:VA
Mailing Address - Zip Code:23923-0728
Mailing Address - Country:US
Mailing Address - Phone:434-542-5171
Mailing Address - Fax:434-542-5809
Practice Address - Street 1:120 DAVID BRUCE AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE C H
Practice Address - State:VA
Practice Address - Zip Code:23923-0728
Practice Address - Country:US
Practice Address - Phone:434-542-5171
Practice Address - Fax:434-542-5809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009106308Medicaid
118025OtherBCBS OF VA
VA3872030001Medicare ID - Type Unspecified
VA009106308Medicaid