Provider Demographics
NPI:1336326792
Name:WELCH PHARMACY INC
Entity Type:Organization
Organization Name:WELCH PHARMACY INC
Other - Org Name:CITIZENS DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:304-888-0818
Mailing Address - Street 1:70 WYOMING ST
Mailing Address - Street 2:
Mailing Address - City:WELCH
Mailing Address - State:WV
Mailing Address - Zip Code:24801-2431
Mailing Address - Country:US
Mailing Address - Phone:304-436-4932
Mailing Address - Fax:304-436-6307
Practice Address - Street 1:70 WYOMING ST
Practice Address - Street 2:
Practice Address - City:WELCH
Practice Address - State:WV
Practice Address - Zip Code:24801-2431
Practice Address - Country:US
Practice Address - Phone:304-436-4932
Practice Address - Fax:304-436-6307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WVSP05523703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2111654OtherPK
5054630OtherNCPDP PROVIDER IDENTIFICATION NUMBER