Provider Demographics
NPI:1346567377
Name:FAMILY PHARMACY OF RIPLEY, INC
Entity Type:Organization
Organization Name:FAMILY PHARMACY OF RIPLEY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:CHAD
Authorized Official - Last Name:FOREMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:304-674-4677
Mailing Address - Street 1:210 PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:WV
Mailing Address - Zip Code:26150-9635
Mailing Address - Country:US
Mailing Address - Phone:304-483-0207
Mailing Address - Fax:
Practice Address - Street 1:194 PINNELL ST
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271-9101
Practice Address - Country:US
Practice Address - Phone:304-483-0207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-30
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6453970001Medicare NSC