Provider Demographics
NPI:1225014574
Name:RED DOT PHARMACY INC
Entity Type:Organization
Organization Name:RED DOT PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-986-3486
Mailing Address - Street 1:131 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MANNINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26582-1130
Mailing Address - Country:US
Mailing Address - Phone:304-986-3486
Mailing Address - Fax:304-986-1785
Practice Address - Street 1:131 MARKET ST
Practice Address - Street 2:
Practice Address - City:MANNINGTON
Practice Address - State:WV
Practice Address - Zip Code:26582-1130
Practice Address - Country:US
Practice Address - Phone:304-986-3486
Practice Address - Fax:304-986-1785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0003726333600000X
WVRP0002474333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0143327000Medicaid
WV0143327000Medicaid