Provider Demographics
NPI:1962509703
Name:DISCOUNT EMPORIUM INC
Entity Type:Organization
Organization Name:DISCOUNT EMPORIUM INC
Other - Org Name:DRUG EMPORIUM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P OF PHARMACY SERVICES
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:25387-2539
Mailing Address - Country:US
Mailing Address - Phone:304-345-4836
Mailing Address - Fax:304-345-4972
Practice Address - Street 1:5101 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2148
Practice Address - Country:US
Practice Address - Phone:304-925-8022
Practice Address - Fax:304-925-2915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
WVMP05502013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0140530000Medicaid
2110658OtherPK
0320410003Medicare NSC