Provider Demographics
NPI:1639256316
Name:BROWN BAILEY & BLANKENSHIP INC
Entity Type:Organization
Organization Name:BROWN BAILEY & BLANKENSHIP INC
Other - Org Name:TOWN PHARMACY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:CONLEY
Authorized Official - Last Name:BLANKENSHIP
Authorized Official - Suffix:SR
Authorized Official - Credentials:RPH
Authorized Official - Phone:304-583-2863
Mailing Address - Street 1:300 MAIN ST
Mailing Address - Street 2:BOX 445
Mailing Address - City:MAN
Mailing Address - State:WV
Mailing Address - Zip Code:25635-1342
Mailing Address - Country:US
Mailing Address - Phone:304-583-2863
Mailing Address - Fax:304-583-2899
Practice Address - Street 1:300 MAIN ST
Practice Address - Street 2:
Practice Address - City:MAN
Practice Address - State:WV
Practice Address - Zip Code:25635-1342
Practice Address - Country:US
Practice Address - Phone:304-583-2863
Practice Address - Fax:304-583-2899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSP05522983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6005065000Medicaid
WV6005065000Medicaid