Healthcare Provider Details

I. General information

NPI: 1174600696
Provider Name (Legal Business Name): PATTERSONS DRUG STORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 HOVATTER DR
INWOOD WV
25428
US

IV. Provider business mailing address

PO BOX 339
INWOOD WV
25428
US

V. Phone/Fax

Practice location:
  • Phone: 304-229-2929
  • Fax: 304-229-0618
Mailing address:
  • Phone: 304-229-2929
  • Fax: 304-229-0618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberMP0550937
License Number StateWV

VIII. Authorized Official

Name: MR. GEORGE KAROS
Title or Position: OWNER
Credential: RPH
Phone: 304-229-2929