NPIMap

Organization Active NPI

Pharmacole Inc

  • Pharmacy
  • Sistersville, WV
National Provider Identifier
1104233329
Registry record updated Jul 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
SP0552376 Issued in WV
Legal business name
PHARMACOLE INC
Doing business as
Sistersville Pharmacy
Practice address
312 Diamond St
Sistersville, WV 26175-1354
Phone
(304) 652-3711
Fax
(304) 652-2371
NPI assigned
Jul 21, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2014

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

Authorized official

Name
Jason Turner
Title
Pharmacist
Phone
(304) 845-0390

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X SP0552376 WV Primary

Addresses

Primary practice location

312 Diamond St
Sistersville, WV 26175-1354

Mailing address

118 Lafayette Ave
Moundsville, WV 26041-1029
Phone (304) 845-0390

Other identifiers 1

IdentifierTypeStateIssuer
2146947OtherPK

Other names 1

  • Sistersville Pharmacy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181016004081 WV Part B Supplier - Mass Immunization (Roster Biller Only) 6204835275 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: New Martinsville, WV; Sistersville, WV

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
51D2249503Sistersville Pharmacy312 Diamond Street, Sistersville, WV 26175Certificate of waiverJan 19, 2028

National Provider Directory

National Provider Directory
Tax ID family
Pharmacole Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

193 N State Route 2
New Martinsville, WV 26155
Phone (304) 455-2171

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1405900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405900800000",
    "number": "1104233329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 LAFAYETTE AVE",
            "city": "MOUNDSVILLE",
            "state": "WV",
            "postal_code": "260411029",
            "telephone_number": "304-845-0390",
            "fax_number": "304-845-0391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 DIAMOND ST",
            "city": "SISTERSVILLE",
            "state": "WV",
            "postal_code": "261751354",
            "telephone_number": "304-652-3711",
            "fax_number": "304-652-2371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHARMACOLE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-21",
        "last_updated": "2014-07-21",
        "status": "A",
        "authorized_official_last_name": "TURNER",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "304-845-0390"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "WV",
            "license": "SP0552376",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2146947",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sistersville Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.