Healthcare Provider Details

I. General information

NPI: 1205227634
Provider Name (Legal Business Name): BRADSHAW ECONOMY DRUG INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2015
Last Update Date: 02/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10029 MARSHALL HIGHWAY
BRADSHAW WV
24817
US

IV. Provider business mailing address

PO BOX 205
HURLEY VA
24620-0205
US

V. Phone/Fax

Practice location:
  • Phone: 307-967-9333
  • Fax: 304-967-9355
Mailing address:
  • Phone: 307-967-9333
  • Fax: 304-967-9355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL BROYLES
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 304-967-9333