Healthcare Provider Details

I. General information

NPI: 1467546770
Provider Name (Legal Business Name): PASTM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4352 5TH STREET RD
HUNTINGTON WV
25701-9558
US

IV. Provider business mailing address

4352 5TH STREET RD
HUNTINGTON WV
25701-9558
US

V. Phone/Fax

Practice location:
  • Phone: 304-523-5003
  • Fax: 304-523-2462
Mailing address:
  • Phone: 304-523-5003
  • Fax: 304-523-2462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberSP0552277
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PETER THOMAS
Title or Position: PHARMACIST
Credential: RPH
Phone: 304-523-5003