Active NPI
Levisa Pharmacies Inc
Doing business as Tri-State Pharmacy
- Community/Retail Pharmacy
- Grundy, VA
National Provider Identifier
1568565604
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 0201002326
- Legal business name
- LEVISA PHARMACIES INC
- Doing business as
- Tri-State Pharmacy
- Practice address
- 20759 Riverside Dr
Grundy, VA 24614-6746 - Phone
- (276) 935-7513
- Fax
- (276) 935-2256
- NPI assigned
- Sep 6, 2006
- Last updated
- Dec 17, 2010
- 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
- Joel Thornbury, BS PHARMACY
- Title
- VP
- Phone
- (276) 935-7513
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | NU | ||
| Community/Retail Pharmacy | 3336C0003X | 0201002326 | VA | Primary |
Addresses
Primary practice location
20759 Riverside Dr
Grundy, VA 24614-6746
Mailing address
PO Box 2048
Grundy, VA 24614-2048
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4820204 | Other | NCPDP PROVIDER IDENTIFICATION NUMBER | |
| 8515514 | Medicaid | VA | |
| 9137289 | Medicaid | VA | |
| 54020326 | Medicaid | KY |
Other names 1
- TRI-STATE PHARMACY
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157500800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1292544000000",
"number": "1568565604",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2048",
"city": "GRUNDY",
"state": "VA",
"postal_code": "246142048"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20759 RIVERSIDE DR",
"city": "GRUNDY",
"state": "VA",
"postal_code": "246146746",
"telephone_number": "276-935-7513",
"fax_number": "276-935-2256"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LEVISA PHARMACIES INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-06",
"last_updated": "2010-12-17",
"status": "A",
"authorized_official_last_name": "THORNBURY",
"authorized_official_first_name": "JOEL",
"authorized_official_title_or_position": "VP",
"authorized_official_telephone_number": "276-935-7513",
"authorized_official_credential": "BS PHARMACY"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "VA",
"license": "0201002326",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
"identifier": "4820204",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8515514",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9137289",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "54020326",
"state": "KY"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "TRI-STATE PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Grundy, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.