Provider Demographics
NPI:1093813263
Name:PHARMACY ASSOCIATES, INC
Entity Type:Organization
Organization Name:PHARMACY ASSOCIATES, INC
Other - Org Name:COMPRECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPECIALTY PHARMACY OPERATIONS MANAG
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:304-529-2143
Mailing Address - Street 1:4501 MACCORKLE AVE SW STE 101
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1444
Mailing Address - Country:US
Mailing Address - Phone:800-815-7540
Mailing Address - Fax:304-766-9301
Practice Address - Street 1:4501 MACCORKLE AVE SW STE 101
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1444
Practice Address - Country:US
Practice Address - Phone:800-815-7540
Practice Address - Fax:304-766-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2007011092332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0144228002Medicaid
KY90269044Medicaid
OH0670939Medicaid
WV0144228002Medicaid