Provider Demographics
NPI:1043831761
Name:WILLIAMSBURG PHARMACY INC
Entity type:Organization
Organization Name:WILLIAMSBURG PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:SETH
Authorized Official - Last Name:RUBY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:814-407-4742
Mailing Address - Street 1:318 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16693-1006
Mailing Address - Country:US
Mailing Address - Phone:814-407-4742
Mailing Address - Fax:814-407-4957
Practice Address - Street 1:318 E 1ST ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:PA
Practice Address - Zip Code:16693-1006
Practice Address - Country:US
Practice Address - Phone:240-527-5556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-04
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy