Provider Demographics
NPI:1831100346
Name:WESLEY DRUGS INC
Entity Type:Organization
Organization Name:WESLEY DRUGS INC
Other - Org Name:WESLEY DRUG COMPANY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DANDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-787-6181
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:42539-0160
Mailing Address - Country:US
Mailing Address - Phone:606-787-5689
Mailing Address - Fax:606-787-6181
Practice Address - Street 1:535 MIDDLEBURG ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:42539
Practice Address - Country:US
Practice Address - Phone:606-787-5689
Practice Address - Fax:606-787-6181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KYPOO7673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1806124OtherNCPDP PROVIDER IDENTIFICATION NUMBER
KY54001144Medicaid
0744400001Medicare NSC