Healthcare Provider Details

I. General information

NPI: 1922926443
Provider Name (Legal Business Name): SPG VIENNA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 GRAND CENTRAL MALL
VIENNA WV
26105-4100
US

IV. Provider business mailing address

PO BOX 3506
ZANESVILLE OH
43702-3506
US

V. Phone/Fax

Practice location:
  • Phone: 304-295-7356
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ERIC B. BLAKE
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 740-452-7685