Provider Demographics
NPI:1396818423
Name:NORRIS PHARMACY INC
Entity Type:Organization
Organization Name:NORRIS PHARMACY INC
Other - Org Name:NORRIS PHARMACY, MEDICINE SHOPPE 2039
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-366-2710
Mailing Address - Street 1:PO BOX 389
Mailing Address - Street 2:
Mailing Address - City:PINE GROVE
Mailing Address - State:WV
Mailing Address - Zip Code:26419-0389
Mailing Address - Country:US
Mailing Address - Phone:304-889-3131
Mailing Address - Fax:304-889-3315
Practice Address - Street 1:300 STATE RT 20
Practice Address - Street 2:
Practice Address - City:PINE GROVE
Practice Address - State:WV
Practice Address - Zip Code:26419
Practice Address - Country:US
Practice Address - Phone:304-889-3131
Practice Address - Fax:304-889-3315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
WVSP05523493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1396818423Medicaid
2111634OtherPK
5830600001Medicare NSC