Provider Demographics
NPI:1952802993
Name:JAMES DRUG STORE - MARTINSBURG INC
Entity Type:Organization
Organization Name:JAMES DRUG STORE - MARTINSBURG INC
Other - Org Name:JAMES DRUG STORE - MARTINSBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:DELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-419-7800
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:LORETTO
Mailing Address - State:PA
Mailing Address - Zip Code:15940-0086
Mailing Address - Country:US
Mailing Address - Phone:814-419-7800
Mailing Address - Fax:814-419-8534
Practice Address - Street 1:119 W ALLEGHENY ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:PA
Practice Address - Zip Code:16662-1103
Practice Address - Country:US
Practice Address - Phone:814-614-4448
Practice Address - Fax:814-614-4541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-26
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4827723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176115OtherPK