Provider Demographics
NPI:1083784979
Name:LOUCAS-KARNOUPAKIS ENTERPRISES INC
Entity Type:Organization
Organization Name:LOUCAS-KARNOUPAKIS ENTERPRISES INC
Other - Org Name:NEW CUMBERLAND RX CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KARNOUPAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-387-2731
Mailing Address - Street 1:PO BOX 198
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:WV
Mailing Address - Zip Code:26034-0198
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:NEW CUMBERLAND
Practice Address - State:WV
Practice Address - Zip Code:26047-0518
Practice Address - Country:US
Practice Address - Phone:304-564-3272
Practice Address - Fax:304-564-3276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WVMP05508103336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0143374000Medicaid
5006968OtherOTHER ID NUMBER
0683140001Medicare NSC