=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043617269
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COX FAMILY PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2014
-----------------------------------------------------
Last Update Date | 03/21/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2012 GARFIELD AVE STE 3
-----------------------------------------------------
City | PARKERSBURG
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26101-2527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-893-9100
-----------------------------------------------------
Fax | 304-893-9103
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2012 GARFIELD AVE STE 3
-----------------------------------------------------
City | PARKERSBURG
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26101-2527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-893-9100
-----------------------------------------------------
Fax | 304-893-9103
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY OWNER
-----------------------------------------------------
Name | MICHAEL COX
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 304-893-9100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | SP0552485
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------