Provider Demographics
NPI:1457355489
Name:FAMILY DISCOUNT PHARMACY OF STOLLINGS, INC
Entity Type:Organization
Organization Name:FAMILY DISCOUNT PHARMACY OF STOLLINGS, INC
Other - Org Name:FAMILY DISCOUNT PHARMACY OF STOLLINGS, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PROPRIETOR/RPH
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:THORNHILL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:304-752-5351
Mailing Address - Street 1:PO BOX 380
Mailing Address - Street 2:
Mailing Address - City:STOLLINGS
Mailing Address - State:WV
Mailing Address - Zip Code:25646-0380
Mailing Address - Country:US
Mailing Address - Phone:304-752-0082
Mailing Address - Fax:304-752-9600
Practice Address - Street 1:153 STOLLINGS AVE
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-4010
Practice Address - Country:US
Practice Address - Phone:304-752-0082
Practice Address - Fax:304-752-9600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSP0550155333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0139392000Medicaid
WV0504060001Medicare NSC