1326147216 NPI number — PRUNTYS PHARMACY INC

Table of content: (NPI 1326147216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326147216 NPI number — PRUNTYS PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRUNTYS PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326147216
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 28
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLEBOURNE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26149-0028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLEBOURNE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-758-4300
Provider Business Practice Location Address Fax Number:
304-758-4365
Provider Enumeration Date:
09/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PUNTY
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
304-758-4300

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: SP0550195 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5009116 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0139623000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com