Blacksburg Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

0201004568 Issued in VA

Legal business name

BLACKSBURG PHARMACY INC

Doing business as

Blacksburg Pharmacy

Practice address

1445 N Main St
Blacksburg, VA 24060-2563

Phone

(540) 552-3000

Fax

(540) 552-3005

NPI assigned

Apr 16, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Senthil Marimuthu

Title

President

Phone

(540) 320-3345

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Blacksburg Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in VA2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare medical equipment & supply locations

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer Renae Bradley, PHARMD

  • Pharmacist
  • Blacksburg, VA
  • NPI 1174298731
  NPD (past)
• Emilie Miller Tolliver

  • Pharmacist
  • Christiansburg, VA
  • NPI 1952877284
  NPD (past)
• Connor McCormick Jarrendt, PHARMD

  • Pharmacist
  • Miamisburg, OH
  • NPI 1588131916
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1397606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725840000000",
    "number": "1205255312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1445 N MAIN ST",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240602563",
            "telephone_number": "540-552-3000",
            "fax_number": "540-552-3005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1445 N MAIN ST",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240602563",
            "telephone_number": "540-552-3000",
            "fax_number": "540-552-3005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACKSBURG PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-16",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A",
        "authorized_official_last_name": "MARIMUTHU",
        "authorized_official_first_name": "SENTHIL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "540-320-3345"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "VA",
            "license": "0201004568",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1205255312",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2145266",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blacksburg Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Anna Blevins, LPTA
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• Community/Retail Pharmacy in Blacksburg, VA
• Providers in Blacksburg, VA by specialty
• Community/Retail Pharmacy in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.