Healthcare Provider Details

I. General information

NPI: 1811938269
Provider Name (Legal Business Name): STAKERS DRUGS EAST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 CENTER ST
WHEELERSBURG OH
45694-1706
US

IV. Provider business mailing address

313 CENTER ST
WHEELERSBURG OH
45694-1706
US

V. Phone/Fax

Practice location:
  • Phone: 740-574-2874
  • Fax: 740-574-8883
Mailing address:
  • Phone: 740-574-2874
  • Fax: 740-574-8883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number020393700
License Number StateOH

VIII. Authorized Official

Name: RHONDA KING
Title or Position: MANAGER
Credential:
Phone: 740-574-2874