Healthcare Provider Details

I. General information

NPI: 1730026584
Provider Name (Legal Business Name): JEFFERSON PHARMACY INC LTC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S PRESTON ST
RANSON WV
25438-1676
US

IV. Provider business mailing address

201 S PRESTON ST
RANSON WV
25438-1676
US

V. Phone/Fax

Practice location:
  • Phone: 304-725-6533
  • Fax: 304-725-4330
Mailing address:
  • Phone: 304-725-6533
  • Fax: 304-725-4330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAMES SCOTT BOYD
Title or Position: PRESIDENT
Credential:
Phone: 304-229-3879