NPIMap

Organization Active NPI

Willow Drug Incorporated

Doing business as Willow Drug

  • Community/Retail Pharmacy
  • Spencer, WV
National Provider Identifier
1962788364
Registry record updated Apr 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
SP0552428 Issued in WV
Legal business name
WILLOW DRUG INCORPORATED
Doing business as
Willow Drug
Practice address
41 Williams Dr
Spencer, WV 25276-1825
Phone
(304) 927-3784
Fax
(304) 927-0333
NPI assigned
Oct 29, 2011
Last updated
Apr 5, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2022

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

Authorized official

Name
Kenly Morrison, PHARMDNPI 1952551285
Title
President/Owner
Phone
(304) 927-3784

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X SP0552428 WV Primary

Addresses

Primary practice location

41 Williams Dr
Spencer, WV 25276-1825

Mailing address

41 Williams Dr
Spencer, WV 25276-1825
Phone (304) 927-3784

Other identifiers 2

IdentifierTypeStateIssuer
5055606OtherNCPDP PROVIDER IDENTIFICATION NUMBER
3810022178MedicaidWV

Other names 1

  • Willow Drug Doing business as

National Provider Directory

National Provider Directory

Locations

41 Williams Dr
Spencer, WV 25276
Phone (304) 927-1222

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1319846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649116800000",
    "number": "1962788364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 WILLIAMS DR",
            "city": "SPENCER",
            "state": "WV",
            "postal_code": "252761825",
            "telephone_number": "304-927-3784",
            "fax_number": "304-927-0333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 WILLIAMS DR",
            "city": "SPENCER",
            "state": "WV",
            "postal_code": "252761825",
            "telephone_number": "304-927-3784",
            "fax_number": "304-927-0333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW DRUG INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-29",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A",
        "authorized_official_last_name": "MORRISON",
        "authorized_official_first_name": "KENLY",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "304-927-3784",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WV",
            "license": "SP0552428",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5055606",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810022178",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Drug",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Willow Drug",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spencer, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.