Community Resource Pharmacy

Primary specialty

Public Health or Welfare AgencyTaxonomy code 251K00000X

License

0201004069 Issued in VA

Legal business name

COMMUNITY RESOURCE PHARMACY

Practice address

26317 West Washington Street,
Extended Building #110
Petersburg, VA 23803

Phone

(804) 524-7657

Fax

(804) 524-7079

NPI assigned

Mar 14, 2006

Organization subpart

No

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

Authorized official

Name

Mr. John E. Wall, R.PH.

Title

Pharmacist-in-Charge

Phone

(804) 524-7657

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1598733768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4030",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238030030",
            "telephone_number": "804-524-7657",
            "fax_number": "804-524-7079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26317 WEST WASHINGTON STREET,",
            "address_2": "EXTENDED BUILDING #110",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "23803",
            "telephone_number": "804-524-7657",
            "fax_number": "804-524-7079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY RESOURCE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PHARMACIST-IN-CHARGE",
        "authorized_official_telephone_number": "804-524-7657",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "VA",
            "license": "0201004069",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP NUMBER",
            "identifier": "4813297",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Commonwealth of Virginia State Board of Health
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• Public Health or Welfare Agency in Petersburg, VA
• Providers in Petersburg, VA by specialty
• Public Health or Welfare Agency in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.