Provider Demographics
NPI:1609235795
Name:DIGNITY HOSPICE OF SOUTHERN WEST VIRGINIA INC
Entity Type:Organization
Organization Name:DIGNITY HOSPICE OF SOUTHERN WEST VIRGINIA INC
Other - Org Name:DIGNITY RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:304-855-4764
Mailing Address - Street 1:PO BOX 4304
Mailing Address - Street 2:
Mailing Address - City:CHAPMANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25508-4304
Mailing Address - Country:US
Mailing Address - Phone:304-855-4764
Mailing Address - Fax:304-831-6001
Practice Address - Street 1:557 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CHAPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508
Practice Address - Country:US
Practice Address - Phone:304-855-4764
Practice Address - Fax:304-831-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WVSP05525043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159617OtherPK
7139750001Medicare PIN