Provider Demographics
NPI:1407290224
Name:UNIQCARE PHARMACY
Entity Type:Organization
Organization Name:UNIQCARE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:EBBERT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:304-553-5716
Mailing Address - Street 1:3538 TEAYS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9054
Mailing Address - Country:US
Mailing Address - Phone:888-698-4908
Mailing Address - Fax:888-808-0795
Practice Address - Street 1:3538 TEAYS VALLEY RD
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9054
Practice Address - Country:US
Practice Address - Phone:888-698-4908
Practice Address - Fax:888-808-0795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy