Provider Demographics
NPI:1760772487
Name:HEALTH FACILITIES INC
Entity Type:Organization
Organization Name:HEALTH FACILITIES INC
Other - Org Name:TYGART VALLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-636-6767
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26280-0309
Mailing Address - Country:US
Mailing Address - Phone:304-335-6005
Mailing Address - Fax:304-335-6009
Practice Address - Street 1:46 TOWN CENTER PLAZA
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WV
Practice Address - Zip Code:26280
Practice Address - Country:US
Practice Address - Phone:304-335-6005
Practice Address - Fax:304-335-6009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WVSP05524213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2129827OtherPK