Provider Demographics
NPI:1053770727
Name:MAO PHARMACY INC.
Entity type:Organization
Organization Name:MAO PHARMACY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SHUBHRO
Authorized Official - Middle Name:
Authorized Official - Last Name:PAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-288-3620
Mailing Address - Street 1:5823 PATTERSON AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2536
Mailing Address - Country:US
Mailing Address - Phone:804-288-1933
Mailing Address - Fax:804-288-1510
Practice Address - Street 1:224 GREAT BRIDGE BLVD STE 161B
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3904
Practice Address - Country:US
Practice Address - Phone:757-547-2247
Practice Address - Fax:757-547-2244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
VA02010046873336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2158221OtherPK