Provider Demographics
NPI:1174537427
Name:PROPHAR CORP.
Entity type:Organization
Organization Name:PROPHAR CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIEF PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:GOLOMBEK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:757-539-7075
Mailing Address - Street 1:948 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-4315
Mailing Address - Country:US
Mailing Address - Phone:757-539-7075
Mailing Address - Fax:757-539-7592
Practice Address - Street 1:948 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4315
Practice Address - Country:US
Practice Address - Phone:757-539-7075
Practice Address - Fax:757-539-7592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010038353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008519714Medicaid