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General NPI Number Information
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NPI Number | 1710908777
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Entity Type | Organization
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Legal Business Name | PRESCRIPTION SHOP LLC
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 04/05/2012
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Provider Practice Location Address
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Address Line | 1212 JOHNSON AVE
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City | BRIDGEPORT
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State | WV
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Zip | 26330-1354
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Country | US
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Telephone | 304-842-3763
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Fax | 304-842-7648
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Provider Business Mailing Address
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Address Line | PO BOX 4638
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City | BRIDGEPORT
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State | WV
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Zip | 26330-4638
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Country | US
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Telephone | 304-842-3763
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Fax | 304-842-7648
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Authorized Official
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Title or Position | OWNER
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Name | MR. ADAM JOSEPH STARKEY
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Credential | RPH
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Telephone | 304-842-3763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | SP0552384
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License Number State | WV
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