Provider Demographics
NPI:1528771045
Name:AMELIA PHARMACY INC
Entity type:Organization
Organization Name:AMELIA PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:GREGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-382-5028
Mailing Address - Street 1:3509 RICHARDS RUN
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-5826
Mailing Address - Country:US
Mailing Address - Phone:804-382-5028
Mailing Address - Fax:
Practice Address - Street 1:15412 PATRICK HENRY HWY
Practice Address - Street 2:
Practice Address - City:AMELIA COURT HOUSE
Practice Address - State:VA
Practice Address - Zip Code:23002-4725
Practice Address - Country:US
Practice Address - Phone:804-561-6885
Practice Address - Fax:804-561-6897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010061377Medicaid