Provider Demographics
NPI:1174556294
Name:FAMILY DISCOUNT PHARMACY, INC.
Entity type:Organization
Organization Name:FAMILY DISCOUNT PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, HEAD PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:276-627-0536
Mailing Address - Street 1:PO BOX 477
Mailing Address - Street 2:
Mailing Address - City:STANLEYTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:24168-0477
Mailing Address - Country:US
Mailing Address - Phone:276-627-0536
Mailing Address - Fax:276-627-6074
Practice Address - Street 1:335 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BASSETT
Practice Address - State:VA
Practice Address - Zip Code:24055-4245
Practice Address - Country:US
Practice Address - Phone:276-627-0536
Practice Address - Fax:276-627-6074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201003494333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4832641OtherNABP