Healthcare Provider Details

I. General information

NPI: 1144308768
Provider Name (Legal Business Name): FAIRFIELD PHARMACY INC
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

701 HENDRICKS ST.
WAYNE WV
25570
US

IV. Provider business mailing address

PO BOX 338
WAYNE WV
25570-0338
US

V. Phone/Fax

Practice location:
  • Phone: 304-272-5122
  • Fax: 304-272-5168
Mailing address:
  • Phone: 304-272-5122
  • Fax: 304-272-5168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberSP0550315
License Number StateWV

VIII. Authorized Official

Name: AMOS EUGENE LEMASTER SR.
Title or Position: PIC
Credential: PHARMACIST
Phone: 304-272-5122