Provider Demographics
NPI:1316580939
Name:JW PHARMACY INC
Entity Type:Organization
Organization Name:JW PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:WISEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:270-527-9374
Mailing Address - Street 1:PO BOX 766
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-0766
Mailing Address - Country:US
Mailing Address - Phone:270-527-9374
Mailing Address - Fax:270-527-3152
Practice Address - Street 1:34 US HIGHWAY 68 E UNIT A
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-8336
Practice Address - Country:US
Practice Address - Phone:270-527-9374
Practice Address - Fax:270-527-3152
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JW PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-27
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy