Active NPI
Martin's Pharmacy of Rural Retreat Inc
- Pharmacy
- Rural Retreat, VA
National Provider Identifier
1346891918
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- Legal business name
- MARTIN'S PHARMACY OF RURAL RETREAT INC
- Practice address
- 100 W Buck Ave
Rural Retreat, VA 24368-2515 - Phone
- (276) 250-2160
- Fax
- (276) 250-2184
- NPI assigned
- Sep 25, 2019
- Last updated
- Jun 24, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. William Hampton Hale, PHARM.D.
- Title
- Director of Corporation
- Phone
- (540) 230-4250
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | Primary |
Addresses
Primary practice location
100 W Buck Ave
Rural Retreat, VA 24368-2515
Mailing address
PO Box 699
Pulaski, VA 24301-0699
Phone (540) 230-4250
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200630000088 | VA | Part B Supplier - Pharmacy | 0840612396 | Practice locations: Rural Retreat, VA |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 49D2249225 | Martin's Pharmacy of Rural Retreat Inc | Certificate of waiver | Jan 18, 2028 |
National Provider Directory
National Provider DirectoryLocations
100 W Buck Ave
Rural Retreat, VA 24368
Phone (276) 250-2160
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pharmacist
- Rural Retreat, VA
- NPI 1487372637
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1569369600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1592956800000",
"number": "1346891918",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 699",
"city": "PULASKI",
"state": "VA",
"postal_code": "243010699",
"telephone_number": "540-230-4250",
"fax_number": "540-980-3784"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 W BUCK AVE",
"city": "RURAL RETREAT",
"state": "VA",
"postal_code": "243682515",
"telephone_number": "276-250-2160",
"fax_number": "276-250-2184"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MARTIN'S PHARMACY OF RURAL RETREAT INC",
"organizational_subpart": "NO",
"enumeration_date": "2019-09-25",
"last_updated": "2020-06-24",
"certification_date": "2020-06-24",
"status": "A",
"authorized_official_last_name": "HALE",
"authorized_official_first_name": "WILLIAM",
"authorized_official_middle_name": "HAMPTON",
"authorized_official_title_or_position": "DIRECTOR OF CORPORATION",
"authorized_official_telephone_number": "540-230-4250",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "PHARM.D."
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Rural Retreat, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2020; 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.