Organization
PAUL G. STAKIAS
Active
Other names
PennWay Pharmacy, PENN WAY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL G STAKIAS (OWNER)
(304) 748-0505
Entity
Organization
Contact information
Practice address
3159 MAIN ST, WEIRTON, WV 26062-4711
(304) 748-0505
(304) 748-4436
Mailing address
3159 MAIN ST, WEIRTON, WV 26062-4711
(304) 748-0505
(304) 748-4436
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
SP0550209
WV
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0142197000
—
WV
01
—
2109491
PK
—
Enumeration date
11/07/2006
Last updated
10/11/2019
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