NPIMap

Organization Active NPI

Kilmarnock Pharmacy Inc

Doing business as Main Street Pharmacy

  • Community/Retail Pharmacy
  • Kilmarnock, VA
National Provider Identifier
1528016771
Registry record updated Oct 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
0201004077 Issued in VA
Legal business name
KILMARNOCK PHARMACY INC
Doing business as
Main Street Pharmacy
Practice address
308 N Main St
Kilmarnock, VA 22482-3834
Phone
(804) 435-8818
Fax
(804) 435-8898
NPI assigned
May 4, 2006
Last updated
Oct 10, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2018

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

Authorized official

Name
Caroll Throckmorton, RPHNPI 1265437776
Title
Owner
Phone
(804) 435-8818

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 0201004077 VA Primary
Long Term Care Pharmacy 3336L0003X NU

Addresses

Primary practice location

308 N Main St
Kilmarnock, VA 22482-3834

Mailing address

308 N Main St
Kilmarnock, VA 22482-3834
Phone (804) 435-8818

Other identifiers 2

IdentifierTypeStateIssuer
4839227OtherNCPDP PROVIDER IDENTIFICATION NUMBER
010265975MedicaidVA

Other names 1

  • MAIN STREET PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070313000271 VA Part B Supplier - Other 7810090834 Practice locations: Kilmarnock, VA
O20100930056082 VA DME Supplier - Pharmacy 7810090834 Practice locations: Kilmarnock, VA

National Provider Directory

National Provider Directory
Tax ID family
Kilmarnock Pharmacy Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

308 N Main St
Kilmarnock, VA 22482
Phone (804) 435-8818

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539129600000",
    "number": "1528016771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 N MAIN ST",
            "city": "KILMARNOCK",
            "state": "VA",
            "postal_code": "224823834",
            "telephone_number": "804-435-8818",
            "fax_number": "804-435-8898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 N MAIN ST",
            "city": "KILMARNOCK",
            "state": "VA",
            "postal_code": "224823834",
            "telephone_number": "804-435-8818",
            "fax_number": "804-435-8898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KILMARNOCK PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2018-10-10",
        "status": "A",
        "authorized_official_last_name": "THROCKMORTON",
        "authorized_official_first_name": "CAROLL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "804-435-8818",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "VA",
            "license": "0201004077",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "4839227",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010265975",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MAIN STREET PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MAIN STREET PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kilmarnock, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.