Provider Demographics
NPI:1508277021
Name:4 GUYZ LLC
Entity Type:Organization
Organization Name:4 GUYZ LLC
Other - Org Name:PRESTON FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMASTERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:304-329-6979
Mailing Address - Street 1:17548 VETERANS MEMORIAL HWY
Mailing Address - Street 2:SUITE P
Mailing Address - City:KINGWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26537-9797
Mailing Address - Country:US
Mailing Address - Phone:304-329-6979
Mailing Address - Fax:304-329-6631
Practice Address - Street 1:17548 VETERANS MEMORIAL HWY
Practice Address - Street 2:SUITE P
Practice Address - City:KINGWOOD
Practice Address - State:WV
Practice Address - Zip Code:26537-9797
Practice Address - Country:US
Practice Address - Phone:304-329-6979
Practice Address - Fax:304-329-6631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WVSP05524863336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145810OtherPK
WV7331450001Medicare NSC