Provider Demographics
NPI:1669414967
Name:NEWPORT NEWS PHARMACY LLC
Entity type:Organization
Organization Name:NEWPORT NEWS PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-965-4700
Mailing Address - Street 1:9555 KINGS CHARTER DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-7994
Mailing Address - Country:US
Mailing Address - Phone:804-412-2533
Mailing Address - Fax:888-550-0017
Practice Address - Street 1:9555 KINGS CHARTER DR STE D
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-7994
Practice Address - Country:US
Practice Address - Phone:804-412-2533
Practice Address - Fax:888-550-0017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
VA02010040653336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4839087OtherNCPDP PROVIDER IDENTIFICATION NUMBER
VA010219051Medicaid
6209930001Medicare NSC