Basic Information
| Provider Information | |||||||||
| NPI: | 1821057316 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PHARMACY ASSOCIATES, INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | PURSUECARERX PHARMACY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1308 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257012401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045251222 | ||||||||
| FaxNumber: | 3045256591 | ||||||||
| Practice Location | |||||||||
| Address1: | 1308 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257012401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045251222 | ||||||||
| FaxNumber: | 3045256591 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2006 | ||||||||
| LastUpdateDate: | 01/19/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ALLEN | ||||||||
| AuthorizedOfficialFirstName: | BRANDY | ||||||||
| AuthorizedOfficialMiddleName: | GRACE | ||||||||
| AuthorizedOfficialTitleorPosition: | VP,PHARMACY | ||||||||
| AuthorizedOfficialTelephone: | 9418770703 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | N | Suppliers | Pharmacy | Community/Retail Pharmacy | 3336C0004X | N | Suppliers | Pharmacy | Compounding Pharmacy | 3336H0001X | N | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy | 3336M0002X | N | Suppliers | Pharmacy | Mail Order Pharmacy | 3336S0011X | N | Suppliers | Pharmacy | Specialty Pharmacy | 333600000X | SPO550060 | WV | Y | Suppliers | Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 5138507 | 05 | NJ | MEDICAID | 0670939 | 05 | OH | MEDICAID | 200088730A | 05 | IN | MEDICAID | 3119970 | 05 | NH | MEDICAID | 01912050 | 05 | NY | MEDICAID | 0553982 | 05 | IA | MEDICAID | 100246280B | 05 | OK | MEDICAID | 777902000 | 05 | MD | MEDICAID | 8509620 | 05 | VA | MEDICAID | 0144228000 | 05 | WV | MEDICAID | 5010094 | 01 | NCPDP | OTHER | 7W0060 | 05 | SC | MEDICAID | 806956000 | 05 | ID | MEDICAID | 969777 | 05 | AZ | MEDICAID | 0230163 | 05 | MT | MEDICAID | 5010094 | 05 | MI | MEDICAID | 54022454 | 05 | KY | MEDICAID |