Provider Demographics
NPI:1508610205
Name:PATTERSON'S DRUG STORE, INC.
Entity Type:Organization
Organization Name:PATTERSON'S DRUG STORE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOIZOS-HOBDAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:304-267-8903
Mailing Address - Street 1:134 S QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-3316
Mailing Address - Country:US
Mailing Address - Phone:304-267-8903
Mailing Address - Fax:304-267-9175
Practice Address - Street 1:134 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3316
Practice Address - Country:US
Practice Address - Phone:304-267-8903
Practice Address - Fax:304-267-9175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy