Provider Demographics
NPI:1225037260
Name:PHILLIPS PHARMACY INC.
Entity Type:Organization
Organization Name:PHILLIPS PHARMACY INC.
Other - Org Name:PHILLIPS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:WINLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-684-3888
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:WV
Mailing Address - Zip Code:26170-0001
Mailing Address - Country:US
Mailing Address - Phone:304-684-3784
Mailing Address - Fax:304-684-2358
Practice Address - Street 1:329 2ND ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:WV
Practice Address - Zip Code:26170-1005
Practice Address - Country:US
Practice Address - Phone:304-684-3784
Practice Address - Fax:304-684-2358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0142222000Medicaid
WV0142222000Medicaid