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Organization
PRUNTYS PHARMACY INC
Active
Organization
PRUNTYS PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY PRUNTY (PRESIDENT)
(301) 758-4300
Entity
Organization
Contact information
Practice address
717 WELLS ST, SISTERSVILLE, WV 26175-1325
(304) 652-3711
(304) 652-2371
Mailing address
717 WELLS ST, SISTERSVILLE, WV 26175-1325
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
SP0552272
WV
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0139623001
—
WV
01
—
1073695854
MEDICARE NPI
—
05
—
2119415
—
WV
01
—
5003532
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
10/20/2006
Last updated
07/17/2007
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