Provider Demographics
NPI:1225690910
Name:TRICOUNTY PHARMACY INC
Entity Type:Organization
Organization Name:TRICOUNTY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SPIRO
Authorized Official - Middle Name:
Authorized Official - Last Name:MITIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-756-1260
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:ALUM CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:25003-0095
Mailing Address - Country:US
Mailing Address - Phone:304-756-1260
Mailing Address - Fax:304-756-1262
Practice Address - Street 1:762 LITTLE COAL RIVER RD
Practice Address - Street 2:
Practice Address - City:ALUM CREEK
Practice Address - State:WV
Practice Address - Zip Code:25003-9262
Practice Address - Country:US
Practice Address - Phone:304-756-1260
Practice Address - Fax:304-756-1262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy