Provider Demographics
NPI:1083617799
Name:FOLLANSBEE PHARMACY INC
Entity Type:Organization
Organization Name:FOLLANSBEE PHARMACY INC
Other - Org Name:TRISTATE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BERNABEI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:304-723-6331
Mailing Address - Street 1:651 COLLIERS WAY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-5053
Mailing Address - Country:US
Mailing Address - Phone:304-723-6331
Mailing Address - Fax:304-723-1131
Practice Address - Street 1:651 COLLIERS WAY
Practice Address - Street 2:SUITE 204
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5053
Practice Address - Country:US
Practice Address - Phone:304-723-6331
Practice Address - Fax:304-723-1131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSP0552308333600000X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6001347000Medicaid
FV95491Medicare PIN
WV1044920002Medicare NSC
WV6001347000Medicaid