Provider Demographics
NPI:1235116641
Name:STUCK & ALGER PHARMACY INC
Entity Type:Organization
Organization Name:STUCK & ALGER PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT - PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:MANZUK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:304-725-2621
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:114 W WASHINGTON ST
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-0427
Mailing Address - Country:US
Mailing Address - Phone:304-725-2621
Mailing Address - Fax:304-728-4321
Practice Address - Street 1:114 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-1543
Practice Address - Country:US
Practice Address - Phone:304-725-2621
Practice Address - Fax:304-728-4321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV8502153Medicaid
0391930001Medicare ID - Type Unspecified