Healthcare Provider Details

I. General information

NPI: 1700874278
Provider Name (Legal Business Name): GASSAWAY DRUG COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 ELK ST
GASSAWAY WV
26624-1136
US

IV. Provider business mailing address

620 ELK ST
GASSAWAY WV
26624-1136
US

V. Phone/Fax

Practice location:
  • Phone: 304-364-5193
  • Fax: 304-364-5313
Mailing address:
  • Phone:
  • Fax:

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 NumberSP0550848
License Number StateWV

VIII. Authorized Official

Name: FRANK GRINDO
Title or Position: OWNER
Credential:
Phone: 304-364-5193