Provider Demographics
NPI:1972146314
Name:FIVE STAR PHARMACY
Entity Type:Organization
Organization Name:FIVE STAR PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:SISSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:304-573-1114
Mailing Address - Street 1:2795 RITTER DR
Mailing Address - Street 2:
Mailing Address - City:SHADY SPRING
Mailing Address - State:WV
Mailing Address - Zip Code:25918-8515
Mailing Address - Country:US
Mailing Address - Phone:304-573-1114
Mailing Address - Fax:
Practice Address - Street 1:2795 RITTER DR
Practice Address - Street 2:
Practice Address - City:SHADY SPRING
Practice Address - State:WV
Practice Address - Zip Code:25918-8515
Practice Address - Country:US
Practice Address - Phone:304-573-1114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy