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NPI Code Detail

MEDICARE: JUDYS DRUG STORE INC

MEDICARE: JUDYS DRUG STORE INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336L0003XLong Term Care Pharmacy
2333600000XPharmacy
33336C0003XCommunity/Retail PharmacySP0550070WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22109313OTHERPK

General Provider Information

NPI Number : 1295739654
Entity Type Code : Organization
Provider Name (Legal Business Name) : JUDYS DRUG STORE INC
Provider Business Mailing Address
First Line : 24 N MAIN ST
Second Line :
City : PETERSBURG
State : WV
Zip : 26847-1518
Country : US
Telephone Number : 304-257-1044
Fax Number : 304-257-2681
Provider Business Practice Location Address
First Line : 24 N MAIN ST
Second Line :
City : PETERSBURG
State : WV
Zip : 26847-1518
Country : US
Telephone Number : 304-257-1044
Fax Number : 304-257-2681
Authorized Official
Title or Position : PRESIDENT
Name : EMILY JUDY
Credential : PHARMD
Telephone Number : 304-257-1044
Provider Enumeration Date : 06/13/2005
Last Update Date : 02/15/2017

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1215935309 — TERESA PENNINGTON RN
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Directions to “JUDYS DRUG STORE INC ” Practice Location

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