Provider Demographics
NPI:1952090672
Name:HERBERT J THOMAS MEMORIAL HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:HERBERT J THOMAS MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:THOMAS PHARMACY-KANAWHA AVE SW
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR IT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-414-6145
Mailing Address - Street 1:4619 KANAWHA AVE SW
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1319
Mailing Address - Country:US
Mailing Address - Phone:304-391-5130
Mailing Address - Fax:304-391-5131
Practice Address - Street 1:4619 KANAWHA AVE SW
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1319
Practice Address - Country:US
Practice Address - Phone:304-391-5130
Practice Address - Fax:304-391-5131
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HERBERT J THOMAS MEMORIAL HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-08
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVMP0552577OtherLICENSE NUMBER