Provider Demographics
NPI:1770841637
Name:MACES PHARMACY INC
Entity Type:Organization
Organization Name:MACES PHARMACY INC
Other - Org Name:MACE'S PHARMACY INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-457-4233
Mailing Address - Street 1:204 S CRIM AVE
Mailing Address - Street 2:
Mailing Address - City:BELINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26250-9662
Mailing Address - Country:US
Mailing Address - Phone:304-823-1001
Mailing Address - Fax:304-823-1006
Practice Address - Street 1:204 S CRIM AVE
Practice Address - Street 2:
Practice Address - City:BELINGTON
Practice Address - State:WV
Practice Address - Zip Code:26250-9662
Practice Address - Country:US
Practice Address - Phone:304-823-1001
Practice Address - Fax:304-823-1006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WVMP05523983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810023142Medicaid
2134929OtherPK
WV3810023142Medicaid