Provider Demographics
NPI:1417138462
Name:JARRELLS PHARMACY INC
Entity Type:Organization
Organization Name:JARRELLS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:JARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-763-2442
Mailing Address - Street 1:PO BOX 2027
Mailing Address - Street 2:
Mailing Address - City:SHADY SPRING
Mailing Address - State:WV
Mailing Address - Zip Code:25918-2027
Mailing Address - Country:US
Mailing Address - Phone:304-763-2442
Mailing Address - Fax:304-763-4230
Practice Address - Street 1:2122 RITTER DR
Practice Address - Street 2:
Practice Address - City:DANIELS
Practice Address - State:WV
Practice Address - Zip Code:25832-9372
Practice Address - Country:US
Practice Address - Phone:304-763-2442
Practice Address - Fax:304-763-4230
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JARRELLS PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0139196000Medicaid
1234570001Medicare NSC