Provider Demographics
NPI:1972582401
Name:MANCHESTER HOMES INC
Entity type:Organization
Organization Name:MANCHESTER HOMES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:BAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:540-862-9046
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:CLIFTON FORGE
Mailing Address - State:VA
Mailing Address - Zip Code:24422-0637
Mailing Address - Country:US
Mailing Address - Phone:540-862-9046
Mailing Address - Fax:540-862-0564
Practice Address - Street 1:1413 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLIFTON FORGE
Practice Address - State:VA
Practice Address - Zip Code:24422-1835
Practice Address - Country:US
Practice Address - Phone:540-862-9046
Practice Address - Fax:540-862-0564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201003708333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3896450001Medicare ID - Type UnspecifiedPROVIDER NUMBER