Provider Demographics
NPI:1659479699
Name:FAMILY DRUG INC
Entity Type:Organization
Organization Name:FAMILY DRUG INC
Other - Org Name:FAMILY DRUG INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:LARGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:276-523-1713
Mailing Address - Street 1:PO BOX 777
Mailing Address - Street 2:
Mailing Address - City:BIG STONE GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24219-0777
Mailing Address - Country:US
Mailing Address - Phone:276-523-1713
Mailing Address - Fax:276-523-2931
Practice Address - Street 1:14 E 27TH ST N STE 1
Practice Address - Street 2:
Practice Address - City:BIG STONE GAP
Practice Address - State:VA
Practice Address - Zip Code:24219-3624
Practice Address - Country:US
Practice Address - Phone:276-523-1713
Practice Address - Fax:276-523-2931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
VA02010023533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0201002353OtherBOARD OF PHARMACY
VA8515590Medicaid
2104360OtherPK