Provider Demographics
NPI:1326199324
Name:FOUR WAY DRUG
Entity Type:Organization
Organization Name:FOUR WAY DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT, PIC
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREPIOTIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:276-988-6000
Mailing Address - Street 1:FOUR WAY SHOPPING CENTER
Mailing Address - Street 2:P.O. BOX 730
Mailing Address - City:NORTH TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24630
Mailing Address - Country:US
Mailing Address - Phone:276-988-6000
Mailing Address - Fax:276-988-3987
Practice Address - Street 1:FOUR WAY SHOPPING CENTER
Practice Address - Street 2:
Practice Address - City:NORTH TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24630
Practice Address - Country:US
Practice Address - Phone:276-988-6000
Practice Address - Fax:276-988-3987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201002839183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008509867Medicaid
WV0141471000Medicaid
WV0141471000Medicaid