Healthcare Provider Details

I. General information

NPI: 1659358513
Provider Name (Legal Business Name): BIG FOUR DRUGSTORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TEMPLE ST
HINTON WV
25951-0688
US

IV. Provider business mailing address

300 TEMPLE ST
HINTON WV
25951-0688
US

V. Phone/Fax

Practice location:
  • Phone: 304-466-2323
  • Fax: 304-466-2366
Mailing address:
  • Phone: 304-466-2323
  • Fax: 304-466-2366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberSP0550015
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberSP0550015
License Number StateWV

VIII. Authorized Official

Name: JOHN MARK ELLISON
Title or Position: PHARMACIST MANAGER
Credential: RPH
Phone: 304-466-2323