=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700600541
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MACE'S PHARMACY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2024
-----------------------------------------------------
Last Update Date | 11/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 204 S CRIM AVE
-----------------------------------------------------
City | BELINGTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26250-9662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-823-1001
-----------------------------------------------------
Fax | 304-823-1006
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 204 S CRIM AVE
-----------------------------------------------------
City | BELINGTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26250-9662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-823-1001
-----------------------------------------------------
Fax | 304-823-1006
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST/OWNER
-----------------------------------------------------
Name | MR. RALPH RICHARD MACE III
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 304-457-4233
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------