Provider Demographics
NPI:1568655678
Name:MEDICAL ASSOCIATES PHARMACY INC
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES PHARMACY INC
Other - Org Name:MEDICAL ASSOCIATES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CORONATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-736-4608
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-0245
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 CHATEAU LN
Practice Address - Street 2:STE 3
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1627
Practice Address - Country:US
Practice Address - Phone:304-736-9442
Practice Address - Fax:304-302-0598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WVMP05522623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5011654OtherNCPDP PROVIDER IDENTIFICATION NUMBER
WV8500089000Medicaid
5011654OtherNCPDP PROVIDER IDENTIFICATION NUMBER