Provider Demographics
NPI:1568877470
Name:UNION DRUG, INC.
Entity Type:Organization
Organization Name:UNION DRUG, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:276-523-2100
Mailing Address - Street 1:310 CLOVERLEAF SQ
Mailing Address - Street 2:BUILDING A SUITE 1
Mailing Address - City:BIG STONE GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24219-2752
Mailing Address - Country:US
Mailing Address - Phone:276-523-2100
Mailing Address - Fax:276-523-2101
Practice Address - Street 1:310 CLOVERLEAF SQ
Practice Address - Street 2:BUILDING A SUITE 1
Practice Address - City:BIG STONE GAP
Practice Address - State:VA
Practice Address - Zip Code:24219-2752
Practice Address - Country:US
Practice Address - Phone:276-523-2100
Practice Address - Fax:276-523-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100307500Medicaid
VA1568877470Medicaid