Healthcare Provider Details

I. General information

NPI: 1972664043
Provider Name (Legal Business Name): PHILLIPS DRUG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 WELLS ST
SISTERSVILLE WV
26175-1323
US

IV. Provider business mailing address

615 WELLS ST
SISTERSVILLE WV
26175-1323
US

V. Phone/Fax

Practice location:
  • Phone: 304-652-6131
  • Fax: 304-652-1926
Mailing address:
  • Phone: 304-652-6131
  • Fax: 304-652-1926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberSP0550161
License Number StateWV

VIII. Authorized Official

Name: JAMES PHILLIPS
Title or Position: OWNER
Credential: RP
Phone: 304-652-1531