Healthcare Provider Details

I. General information

NPI: 1326147216
Provider Name (Legal Business Name): PRUNTYS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 MAIN ST
MIDDLEBOURNE WV
26149
US

IV. Provider business mailing address

PO BOX 28
MIDDLEBOURNE WV
26149-0028
US

V. Phone/Fax

Practice location:
  • Phone: 304-758-4300
  • Fax: 304-758-4365
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberSP0550195
License Number StateWV

VIII. Authorized Official

Name: LARRY PUNTY
Title or Position: OWNER PRESIDENT
Credential: RPH
Phone: 304-758-4300