| NPI | 1023114584 |
|---|---|
| Doing Business As | NORTHGATEPHARMACY 1 |
| Entity Type | Organization |
| Authorized Contact | TIMOTHY RUDOLPH PETROSKY Pharmacy Manager/PIC 276-628-2001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: VA 0201002592) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0201002592) |
| 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: VA 0201002592) | |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2015-12-23 |