Provider Demographics
NPI:1518787928
Name:FOUR SEASONS PHARMACY INC
Entity type:Organization
Organization Name:FOUR SEASONS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY TECHNICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DUNFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-487-0015
Mailing Address - Street 1:300 MORRISON DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2765
Mailing Address - Country:US
Mailing Address - Phone:304-487-0015
Mailing Address - Fax:304-487-0005
Practice Address - Street 1:300 MORRISON DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2765
Practice Address - Country:US
Practice Address - Phone:304-487-0015
Practice Address - Fax:304-487-0005
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOUR SEASONS PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-11
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy