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General NPI Number Information
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NPI Number | 1295739654
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Entity Type | Organization
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Legal Business Name | JUDYS DRUG STORE INC
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 02/15/2017
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Provider Practice Location Address
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Address Line | 24 N MAIN ST
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City | PETERSBURG
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State | WV
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Zip | 26847-1518
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Country | US
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Telephone | 304-257-1044
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Fax | 304-257-2681
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Provider Business Mailing Address
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Address Line | 24 N MAIN ST
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City | PETERSBURG
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State | WV
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Zip | 26847-1518
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Country | US
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Telephone | 304-257-1044
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Fax | 304-257-2681
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Authorized Official
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Title or Position | PRESIDENT
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Name | EMILY JUDY
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Credential | PHARMD
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Telephone | 304-257-1044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care 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 | 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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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | SP0550070
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License Number State | WV
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