Healthcare Provider Details
I. General information
NPI: 1942012398
Provider Name (Legal Business Name): EPPYS DRUG STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 01/23/2025
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2987 ROBERT C BYRD DR
BECKLEY WV
25801-4400
US
IV. Provider business mailing address
2987 ROBERT C BYRD DR
BECKLEY WV
25801-4400
US
V. Phone/Fax
- Phone: 304-252-6331
- Fax:
- Phone: 304-252-6331
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 3336C0004X |
| Taxonomy | Compounding Pharmacy |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 3336L0003X |
| Taxonomy | Long Term Care Pharmacy |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
MARY
ELIZABETH
WADE
Title or Position: OWNER
Credential: RPH
Phone: 304-252-6332