Provider Demographics
NPI:1568976272
Name:POWHATAN RX LLC
Entity type:Organization
Organization Name:POWHATAN RX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:WILEY
Authorized Official - Last Name:GOODWYN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:804-376-7168
Mailing Address - Street 1:2105 ACADEMY RD
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-5829
Mailing Address - Country:US
Mailing Address - Phone:804-376-7168
Mailing Address - Fax:804-376-7982
Practice Address - Street 1:2105 ACADEMY RD
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-5829
Practice Address - Country:US
Practice Address - Phone:804-376-7168
Practice Address - Fax:804-376-7982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-17
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010048213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy