Provider Demographics
NPI:1295078624
Name:JANE LEW PHARMACY, LLC.
Entity type:Organization
Organization Name:JANE LEW PHARMACY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:A
Authorized Official - Last Name:GENIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-884-7100
Mailing Address - Street 1:134 INDUSTRIAL PARK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JANE LEW
Mailing Address - State:WV
Mailing Address - Zip Code:26378-9785
Mailing Address - Country:US
Mailing Address - Phone:304-884-7100
Mailing Address - Fax:304-884-7123
Practice Address - Street 1:134 INDUSTRIAL PARK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:JANE LEW
Practice Address - State:WV
Practice Address - Zip Code:26378-9785
Practice Address - Country:US
Practice Address - Phone:304-884-7100
Practice Address - Fax:304-884-7123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy