Provider Demographics
NPI:1801046487
Name:STROSNIDER DRUG
Entity type:Organization
Organization Name:STROSNIDER DRUG
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LA DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:304-393-1390
Mailing Address - Street 1:RT 1 STONECOAL
Mailing Address - Street 2:PO BOX 660
Mailing Address - City:KERMIT
Mailing Address - State:WV
Mailing Address - Zip Code:25674
Mailing Address - Country:US
Mailing Address - Phone:304-393-1390
Mailing Address - Fax:304-393-1396
Practice Address - Street 1:RT 52 STONECOAL
Practice Address - Street 2:
Practice Address - City:CRUM
Practice Address - State:WV
Practice Address - Zip Code:25669
Practice Address - Country:US
Practice Address - Phone:304-393-1390
Practice Address - Fax:304-393-1396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVMP0552370333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy