Provider Demographics
NPI:1598704934
Name:MACE'S PHARMACY, INC.
Entity Type:Organization
Organization Name:MACE'S PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:MACE
Authorized Official - Suffix:III
Authorized Official - Credentials:R PH
Authorized Official - Phone:304-457-4233
Mailing Address - Street 1:440 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PHILIPPI
Mailing Address - State:WV
Mailing Address - Zip Code:26416-0015
Mailing Address - Country:US
Mailing Address - Phone:304-457-4233
Mailing Address - Fax:304-457-6760
Practice Address - Street 1:440 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PHILIPPI
Practice Address - State:WV
Practice Address - Zip Code:26416-0015
Practice Address - Country:US
Practice Address - Phone:304-457-4233
Practice Address - Fax:304-457-6760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2015-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSP0552281183500000X
WVSP0552352333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6003030000Medicaid
WV6003030000Medicaid