MEDICARE: STROSNIDER DRUG STORE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	SP0552280	WV

General Provider Information

NPI Number	:	1477658805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STROSNIDER DRUG STORE INC.

Provider Business Mailing Address
First Line	:	PO BOX 600
Second Line	:	RR 52 50 LINCOLN STREET
City	:	KERMIT
State	:	WV
Zip	:	25674-0600
Country	:	US
Telephone Number	:	304-393-3386
Fax Number	:	304-393-3387

Provider Business Practice Location Address
First Line	:	50 LINCOLN STREET
Second Line	:
City	:	KERMIT
State	:	WV
Zip	:	25674-0600
Country	:	US
Telephone Number	:	304-393-3386
Fax Number	:	304-393-3387

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES P WOOLEY
Credential	:	RPH
Telephone Number	:	304-393-3386

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	01/05/2009

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