Provider Demographics
NPI:1669657649
Name:BARBOURSVILLE FAMILY PHARMACY
Entity Type:Organization
Organization Name:BARBOURSVILLE FAMILY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAC
Authorized Official - Middle Name:EMERY
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:304-204-2588
Mailing Address - Street 1:6007 US ROUTE 60 E
Mailing Address - Street 2:SUITE 230
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1042
Mailing Address - Country:US
Mailing Address - Phone:304-302-0564
Mailing Address - Fax:
Practice Address - Street 1:6007 US ROUTE 60 E
Practice Address - Street 2:SUITE 230
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1042
Practice Address - Country:US
Practice Address - Phone:304-302-0564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSP05523213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5054060OtherNABP