Provider Demographics
NPI:1790782274
Name:FOLLANSBEE PHARMACY, INC
Entity Type:Organization
Organization Name:FOLLANSBEE PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALDO
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CRISANTE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:304-527-1004
Mailing Address - Street 1:1415 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOLLANSBEE
Mailing Address - State:WV
Mailing Address - Zip Code:26037-1217
Mailing Address - Country:US
Mailing Address - Phone:304-527-1004
Mailing Address - Fax:
Practice Address - Street 1:1415 MAIN ST
Practice Address - Street 2:
Practice Address - City:FOLLANSBEE
Practice Address - State:WV
Practice Address - Zip Code:26037-1217
Practice Address - Country:US
Practice Address - Phone:304-527-1004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSP0551249332B00000X, 332BX2000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5010690OtherNABP NUMBER
WV0141273000Medicaid
WVSP0551249OtherSTATE LICENSE NUMBER
OH0244202Medicaid
WVSP0551249OtherSTATE LICENSE NUMBER
1044920001Medicare ID - Type Unspecified