Provider Demographics
NPI:1992781355
Name:FRIENDSHIP PHARMACY INC
Entity type:Organization
Organization Name:FRIENDSHIP PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-777-4044
Mailing Address - Street 1:PO BOX 7587
Mailing Address - Street 2:327 HERSCHBERGER RD NW
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-0587
Mailing Address - Country:US
Mailing Address - Phone:540-265-2153
Mailing Address - Fax:540-265-2154
Practice Address - Street 1:327 HERSHBERGER ROAD NW
Practice Address - Street 2:INSTITUTIONAL PHARMACY BUILDING SUITE 1
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012
Practice Address - Country:US
Practice Address - Phone:540-265-2153
Practice Address - Fax:540-265-2154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201003786333600000X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010007771Medicaid
1042950001Medicare ID - Type Unspecified