NPI: 1154308971 · ROANOKE, VA 24012 · Pharmacy · NPI assigned 12/22/2005
| Authorized Official | SHANNON, CHARLES (CHIEF FINANCIAL OFFICER) |
| NPI Enumeration Date | 12/22/2005 |
| Year | Claims | Total Paid |
|---|---|---|
| 2021 | 31 | $240.00 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| 0004A | 31 | 31 | $240.00 |