CITY PHARMACY (CITY PHARMACY) - NPI NUMBER 1043533003

Summary

Provider Name: CITY PHARMACY (CITY PHARMACY)

NPI Number: 1043533003

Clasification: Pharmacy (3336C0003X)

Specialization: Community/Retail Pharmacy

Address:
970 FOXCROFT AVE
SUITE 101
MARTINSBURG, WV
ZIP 25401

Phone Number: (304) 262-6555



Detailed Information

CITY PHARMACY is a community/retail pharmacy pharmacy in Martinsburg, WV. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. The assigned NPI number for this provider is 1043533003 and is registered as an organization entity type.
The provider Is Doing Business As City Pharmacy.

The provider's business address is:

970 FOXCROFT AVE
SUITE 101
MARTINSBURG, WV
ZIP 25401-835
Phone: (304) 262-6555
Fax: (304) 262-6599

The provider's authorized official is David M Wasanyi .
The authorized official title is Pharmacist and has the following contact phone number (540) 327-6140.

The enumeration date for this NPI number is 3/4/2010 and was last updated on 8/11/2014.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 3336C0003X Pharmacy Community/Retail Pharmacy 27178989 WV Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 7128350001 MEDICARE NSC
2 3810017469 MEDICAID WV
3 FV96311 OTHER MEDICARE PTAN

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1043533003 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name CITY PHARMACY The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name CITY PHARMACY Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 3 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 970 FOXCROFT AVE The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Second Line Business Practice Location Address SUITE 101 The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
9 Provider Business Practice Location Address City Name MARTINSBURG The city name in the location address of the provider being identified.
10 Provider Business Practice Location Address State Name WV The State code in the location of the provider being identified.
11 Provider Business Practice Location Address Postal Code 254011835 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
12 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
13 Provider Business Practice Location Address Telephone Number 3042626555 The telephone number associated with the location address of the provider being identified.
14 Provider Business Practice Location Address Fax Number 3042626599 The fax number associated with the location address of the provider being identified.
15 Provider Enumeration Date 3/4/2010 The date the provider was assigned a unique identifier (assigned an NPI).
16 Last Update Date 8/11/2014 The date that a record was last updated or changed.
17 Authorized Official Last Name WASANYI The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
18 Authorized Official First Name DAVID The first name of the authorized official.
19 Authorized Official Middle Name M The middle name of the authorized official.
20 Authorized Official Title or Position PHARMACIST The title or position of the authorized official.
21 Authorized Official Telephone Number 5403276140 The 10-position telephone number of the authorized official.
22 Healthcare Provider Taxonomy Code 1 3336C0003X
23 Provider License Number 1 27178989 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
24 Provider License Number State Code 1 WV The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
25 Healthcare Provider Primary Taxonomy Switch 1 Y
26 Other Provider Identifier 1 7128350001 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
27 Other Provider Identifier Type Code 1 07 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
28 Other Provider Identifier 2 3810017469 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
29 Other Provider Identifier Type Code 2 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
30 Other Provider Identifier State 2 WV Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
31 Other Provider Identifier 3 FV96311 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
32 Other Provider Identifier Type Code 3 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
33 Other Provider Identifier Issuer 3 MEDICARE PTAN
34 Is Organization Subpart N
35 Authorized Official Name Prefix Text DR.
36 Authorized Official Credential Text PHARM.D

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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