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General NPI Number Information
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NPI Number | 1417067729
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Entity Type | Organization
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Legal Business Name | J W PHARMACY
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 10/11/2016
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Provider Practice Location Address
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Address Line | 817 MAIN ST
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City | BENTON
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State | KY
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Zip | 42025-1240
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Country | US
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Telephone | 270-527-9374
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Fax | 270-527-3152
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Provider Business Mailing Address
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Address Line | 817 MAIN ST
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City | BENTON
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State | KY
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Zip | 42025-1240
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Country | US
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Telephone | 270-527-9374
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Fax | 270-527-3152
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Authorized Official
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Title or Position | OWNER PRES
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Name | JAMES H WISEMAN
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Credential |
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Telephone | 270-527-9374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 00663
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 00663
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License Number State | KY
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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 | 00663
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License Number State | KY
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