Provider Demographics
NPI:1669430641
Name:NTA, LTD
Entity type:Organization
Organization Name:NTA, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:WALDEN
Authorized Official - Last Name:ABERNATHY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:804-448-2606
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:LADYSMITH
Mailing Address - State:VA
Mailing Address - Zip Code:22501-0010
Mailing Address - Country:US
Mailing Address - Phone:804-448-2606
Mailing Address - Fax:804-448-0159
Practice Address - Street 1:18014 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:RUTHER GLEN
Practice Address - State:VA
Practice Address - Zip Code:22546-2922
Practice Address - Country:US
Practice Address - Phone:804-448-2606
Practice Address - Fax:804-448-0159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010013073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4813918OtherNCPDP