Provider Demographics
NPI:1215009014
Name:HOGE DAVIS DRUG CO
Entity Type:Organization
Organization Name:HOGE DAVIS DRUG CO
Other - Org Name:ELM GROVE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:ANGELO
Authorized Official - Last Name:MARTINO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:304-242-1500
Mailing Address - Street 1:102 EAST BETHLEHEM BLVD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-4866
Mailing Address - Country:US
Mailing Address - Phone:304-242-1500
Mailing Address - Fax:304-242-6889
Practice Address - Street 1:102 EAST BETHLEHEM BLVD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-4866
Practice Address - Country:US
Practice Address - Phone:304-242-1500
Practice Address - Fax:304-242-6889
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOGE DAVIS DRUG CO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WVSP05501233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0141960000Medicaid
5000930OtherOTHER ID NUMBER-COMMERCIAL NUMBER
WVAH2973899OtherDEA #
5000930OtherOTHER ID NUMBER-COMMERCIAL NUMBER
WV0621890001Medicare NSC