NPIMap

Organization Active NPI

Davis Memorial Hospital

Doing business as Davis Specialty Pharmacy

  • Community/Retail Pharmacy
  • Elkins, WV
National Provider Identifier
1003549643
Registry record updated May 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
DAVIS MEMORIAL HOSPITAL
Doing business as
Davis Specialty Pharmacy
Practice address
812 Gorman Ave Ste 204
Elkins, WV 26241-3181
Phone
(304) 637-3622
NPI assigned
Jul 1, 2022
Last updated
May 7, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brandy L Wildman
Title
Director of Revenue Cycle
Phone
(304) 637-3622

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary
Specialty Pharmacy 3336S0011X

Addresses

Primary practice location

812 Gorman Ave Ste 204
Elkins, WV 26241-3181

Mailing address

812 Gorman Ave
PO Box 1484
Elkins, WV 26241
Phone (304) 637-3622

Other names 1

  • Davis Specialty Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221216001390 WV DME Supplier - Pharmacy 3072418540 Practice locations: Elkins, WV

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Member organizations 7

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
HomeplusElkins, WV, CCN 517069 Home health agency 5% Or Greater Direct Ownership Interest (100%) Apr 28, 1969

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1656633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715040000000",
    "number": "1003549643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "812 GORMAN AVE",
            "address_2": "PO BOX 1484",
            "city": "ELKINS",
            "state": "WV",
            "postal_code": "26241",
            "telephone_number": "304-637-3622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 GORMAN AVE STE 204",
            "city": "ELKINS",
            "state": "WV",
            "postal_code": "262413181",
            "telephone_number": "304-637-3622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVIS MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-01",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A",
        "authorized_official_last_name": "WILDMAN",
        "authorized_official_first_name": "BRANDY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE CYCLE",
        "authorized_official_telephone_number": "304-637-3622"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Davis Specialty Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Davis Specialty Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elkins, WV

Sources for this page

Verify at the official NPI Registry.