Active NPI
Justin Drake, PHARM D
- Pharmacist
- Moundsville, WV
National Provider Identifier
1124268370
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- WV7019
- Practice address
- 115 Lafayette Ave
Moundsville, WV 26041-1028 - Phone
- (304) 845-0390
- Fax
- (304) 845-0391
- NPI assigned
- Mar 1, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | WV7019 | WV | Primary |
Addresses
Primary practice location
115 Lafayette Ave
Moundsville, WV 26041-1028
Mailing address
115 Lafayette Ave
Moundsville, WV 26041-1028
Phone (304) 845-0390
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| WV7019 | WV | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pharmacole Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Moundsville, WV
- NPI 1790867570
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1235865600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235865600000",
"number": "1124268370",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 LAFAYETTE AVE",
"city": "MOUNDSVILLE",
"state": "WV",
"postal_code": "260411028",
"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": "115 LAFAYETTE AVE",
"city": "MOUNDSVILLE",
"state": "WV",
"postal_code": "260411028",
"telephone_number": "304-845-0390",
"fax_number": "304-845-0391"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DRAKE",
"first_name": "JUSTIN",
"name_prefix": "Mr.",
"credential": "PHARM D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-03-01",
"last_updated": "2009-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WV",
"license": "WV7019",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moundsville, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.