Provider Demographics
NPI:1275273690
Name:GENERAL DRUG LLC
Entity Type:Organization
Organization Name:GENERAL DRUG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:304-767-5609
Mailing Address - Street 1:336 SYCAMORE RD
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-5885
Mailing Address - Country:US
Mailing Address - Phone:304-767-5609
Mailing Address - Fax:
Practice Address - Street 1:12044 WINFIELD RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:WV
Practice Address - Zip Code:25213-7902
Practice Address - Country:US
Practice Address - Phone:304-767-5609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVSP0552575OtherWV PHARMACY LICENSE
FG0912053OtherDEA LICENSE