Active NPI
Pruntys Pharmacy Inc
- Pharmacy
- Sistersville, WV
National Provider Identifier
1073695854
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- SP0552272
- Legal business name
- PRUNTYS PHARMACY INC
- Practice address
- 717 Wells St
Sistersville, WV 26175-1325 - Phone
- (304) 652-3711
- Fax
- (304) 652-2371
- NPI assigned
- Oct 20, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Larry Prunty
- Title
- President
- Phone
- (301) 758-4300
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | SP0552272 | WV | Primary |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
717 Wells St
Sistersville, WV 26175-1325
Mailing address
717 Wells St
Sistersville, WV 26175-1325
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073695854 | Other | MEDICARE NPI | |
| 2119415 | Medicaid | WV | |
| 0139623001 | Medicaid | WV | |
| 5003532 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
National Provider Directory
National Provider Directory- Tax ID family
- Pruntys Pharmacy Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Pharmacy
- Middlebourne, WV
- NPI 1326147216
Locations
717 Wells St
Sistersville, WV 26175
Phone (304) 652-3711
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161302400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1184630400000",
"number": "1073695854",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "717 WELLS ST",
"city": "SISTERSVILLE",
"state": "WV",
"postal_code": "261751325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "717 WELLS ST",
"city": "SISTERSVILLE",
"state": "WV",
"postal_code": "261751325",
"telephone_number": "304-652-3711",
"fax_number": "304-652-2371"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PRUNTYS PHARMACY INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-10-20",
"last_updated": "2007-07-17",
"status": "A",
"authorized_official_last_name": "PRUNTY",
"authorized_official_first_name": "LARRY",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "301-758-4300"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "WV",
"license": "SP0552272",
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE NPI",
"identifier": "1073695854",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2119415",
"state": "WV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0139623001",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
"identifier": "5003532",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Sistersville, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.