Blue Ridge Apothecary Inc

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

020100003731 Issued in VA

Legal business name

BLUE RIDGE APOTHECARY INC

Practice address

2122 Colonial Ave SW
Roanoke, VA 24015-3205

Phone

(540) 345-6480

Fax

(540) 345-6844

NPI assigned

Apr 24, 2014

Organization subpart

No

Locations

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

Authorized official

Name

Graham Stephens

Title

Owner/Ceo

Phone

(540) 345-6480

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Blue Ridge Apothecary Doing business as

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

{
    "created_epoch": "1398297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487721600000",
    "number": "1447670849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2122 COLONIAL AVE SW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240153205",
            "telephone_number": "540-345-6480",
            "fax_number": "540-345-6844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2122 COLONIAL AVE SW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240153205",
            "telephone_number": "540-345-6480",
            "fax_number": "540-345-6844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE APOTHECARY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-24",
        "last_updated": "2017-02-22",
        "status": "A",
        "authorized_official_last_name": "STEPHENS",
        "authorized_official_first_name": "GRAHAM",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "540-345-6480"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "VA",
            "license": "020100003731",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2160413",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Ridge Apothecary",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Roanoke, VA
• Compounding Pharmacy in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.