Provider Demographics
NPI:1376849372
Name:WHEELER DRUG CORP
Entity Type:Organization
Organization Name:WHEELER DRUG CORP
Other - Org Name:CEDAR BLUFF PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-964-4068
Mailing Address - Street 1:3141 CEDAR VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-3076
Mailing Address - Country:US
Mailing Address - Phone:276-964-4068
Mailing Address - Fax:
Practice Address - Street 1:3141 CEDAR VALLEY DR
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-3076
Practice Address - Country:US
Practice Address - Phone:276-964-4068
Practice Address - Fax:276-963-5013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201001810333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2129545OtherPK