Provider Demographics
NPI:1205227634
Name:BRADSHAW ECONOMY DRUG INC.
Entity Type:Organization
Organization Name:BRADSHAW ECONOMY DRUG INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROYLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-967-9333
Mailing Address - Street 1:PO BOX 205
Mailing Address - Street 2:
Mailing Address - City:HURLEY
Mailing Address - State:VA
Mailing Address - Zip Code:24620-0205
Mailing Address - Country:US
Mailing Address - Phone:307-967-9333
Mailing Address - Fax:304-967-9355
Practice Address - Street 1:10029 MARSHALL HIGHWAY
Practice Address - Street 2:
Practice Address - City:BRADSHAW
Practice Address - State:WV
Practice Address - Zip Code:24817
Practice Address - Country:US
Practice Address - Phone:307-967-9333
Practice Address - Fax:304-967-9355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy