Provider Demographics
NPI:1174953855
Name:BLUE DEVIL DRUG INC
Entity type:Organization
Organization Name:BLUE DEVIL DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:LEANN
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:276-202-5505
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:CASTLEWOOD
Mailing Address - State:VA
Mailing Address - Zip Code:24224-0158
Mailing Address - Country:US
Mailing Address - Phone:276-762-5959
Mailing Address - Fax:
Practice Address - Street 1:19408 HWY 58
Practice Address - Street 2:
Practice Address - City:CASTLEWOOD
Practice Address - State:VA
Practice Address - Zip Code:24224
Practice Address - Country:US
Practice Address - Phone:276-762-5959
Practice Address - Fax:276-762-5755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy