Provider Demographics
NPI:1033402359
Name:FAST & FRIENDLY PHARMACY LLC
Entity Type:Organization
Organization Name:FAST & FRIENDLY PHARMACY LLC
Other - Org Name:FAST & FRIENDLY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:METHENY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-997-5803
Mailing Address - Street 1:PO BOX 621
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-0621
Mailing Address - Country:US
Mailing Address - Phone:304-997-5803
Mailing Address - Fax:
Practice Address - Street 1:1513 HARRISON AVE STE 18
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3356
Practice Address - Country:US
Practice Address - Phone:304-637-5646
Practice Address - Fax:304-637-5647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-19
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WVSP05524193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2130369OtherPK