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General NPI Number Information
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NPI Number | 1205227634
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Entity Type | Organization
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Legal Business Name | BRADSHAW ECONOMY DRUG INC.
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Dates
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Enumeration Date | 02/06/2015
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Last Update Date | 02/06/2015
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Provider Practice Location Address
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Address Line | 10029 MARSHALL HIGHWAY
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City | BRADSHAW
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State | WV
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Zip | 24817
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Country | US
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Telephone | 307-967-9333
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Fax | 304-967-9355
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Provider Business Mailing Address
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Address Line | PO BOX 205
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City | HURLEY
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State | VA
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Zip | 24620-0205
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Country | US
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Telephone | 307-967-9333
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Fax | 304-967-9355
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MICHAEL BROYLES
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Credential |
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Telephone | 304-967-9333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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