Provider Demographics
NPI:1134788649
Name:EAGLE PHARMACY LLC
Entity type:Organization
Organization Name:EAGLE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JITE
Authorized Official - Middle Name:VOKE
Authorized Official - Last Name:URHIE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:304-521-7848
Mailing Address - Street 1:4216 MACCORKLE AVE SE STE 5
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2539
Mailing Address - Country:US
Mailing Address - Phone:681-265-5151
Mailing Address - Fax:681-265-5153
Practice Address - Street 1:4216 MACCORKLE AVE SE STE 5
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2539
Practice Address - Country:US
Practice Address - Phone:681-265-5151
Practice Address - Fax:681-265-5153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-08
Last Update Date:2019-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVOTHEROtherOTHER