Provider Demographics
NPI:1063043891
Name:WHITESVILLE FAMILY PHARMACY, INC
Entity Type:Organization
Organization Name:WHITESVILLE FAMILY PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-854-0825
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:SETH
Mailing Address - State:WV
Mailing Address - Zip Code:25181-0190
Mailing Address - Country:US
Mailing Address - Phone:304-837-3777
Mailing Address - Fax:304-837-3777
Practice Address - Street 1:38800 COAL RIVER RD
Practice Address - Street 2:
Practice Address - City:WHITESVILLE
Practice Address - State:WV
Practice Address - Zip Code:25209
Practice Address - Country:US
Practice Address - Phone:304-854-0825
Practice Address - Fax:304-854-0828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy