Provider Demographics
NPI:1497801161
Name:POCA VALU-RITE, INC
Entity Type:Organization
Organization Name:POCA VALU-RITE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BRAC
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-755-1500
Mailing Address - Street 1:119-C MAIN STREET
Mailing Address - Street 2:PO BOX 962
Mailing Address - City:POCA
Mailing Address - State:WV
Mailing Address - Zip Code:25159
Mailing Address - Country:US
Mailing Address - Phone:304-755-1500
Mailing Address - Fax:
Practice Address - Street 1:119C MAIN STREET
Practice Address - Street 2:
Practice Address - City:POCA
Practice Address - State:WV
Practice Address - Zip Code:25159
Practice Address - Country:US
Practice Address - Phone:304-755-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSP05512213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0141141000Medicaid
WV0141141000Medicaid