Provider Demographics
NPI:1922234376
Name:DISCOUNT EMPORIUM, INC.
Entity Type:Organization
Organization Name:DISCOUNT EMPORIUM, INC.
Other - Org Name:DRUG EMPORIUM WV
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-345-4836
Mailing Address - Street 1:1601 KANAWHA BLVD W
Mailing Address - Street 2:SU 200
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25312-2539
Mailing Address - Country:US
Mailing Address - Phone:304-345-4836
Mailing Address - Fax:304-345-4972
Practice Address - Street 1:1601 KANAWHA BLVD W
Practice Address - Street 2:SU 200
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25312-2539
Practice Address - Country:US
Practice Address - Phone:304-345-4836
Practice Address - Fax:304-345-4972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy