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General NPI Number Information
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NPI Number | 1679661474
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Entity Type | Organization
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Legal Business Name | STAATS PHARMACY AND HEALTH CARE INC
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 01/11/2016
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Provider Practice Location Address
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Address Line | 100 E MAIN ST
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City | SPENCER
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State | WV
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Zip | 25276
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Country | US
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Telephone | 304-927-2980
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Fax | 304-927-3190
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Provider Business Mailing Address
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Address Line | PO BOX 67 100 E MAIN ST
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City | SPENCER
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State | WV
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Zip | 25276-0067
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Country | US
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Telephone | 304-927-2980
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Fax | 304-927-3190
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN E CORKREAN III
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Credential | RPH
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Telephone | 304-927-2980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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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