Provider Demographics
NPI:1487351714
Name:JUDYS DRUG STORE INC
Entity type:Organization
Organization Name:JUDYS DRUG STORE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-257-1044
Mailing Address - Street 1:24 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26847-1518
Mailing Address - Country:US
Mailing Address - Phone:304-257-1044
Mailing Address - Fax:304-257-2857
Practice Address - Street 1:24 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-1518
Practice Address - Country:US
Practice Address - Phone:304-257-1044
Practice Address - Fax:304-257-2857
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JUDYS DRUG STORE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVSP0550070OtherWV BOARD OF PHARMACY
WVSP0550070OtherWV BOARD OF PHARMACY