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General NPI Number Information
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NPI Number | 1023189040
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Entity Type | Organization
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Legal Business Name | STOUTS PHARMACY INC
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 09/28/2010
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Provider Practice Location Address
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Address Line | 3007 DUDLEY AVE
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City | PARKERSBURG
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State | WV
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Zip | 26104-1817
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Country | US
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Telephone | 304-422-6511
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Fax | 304-485-8832
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Provider Business Mailing Address
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Address Line | PO BOX 4321
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City | PARKERSBURG
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State | WV
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Zip | 26104-4321
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Country | US
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Telephone | 304-422-6511
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Fax | 304-485-8832
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRUCE D. PFALZGRAF
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Credential | R.PH.
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Telephone | 304-422-6511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | SP0552220
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | SP0552220
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License Number State | WV
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