Provider Demographics
NPI:1528085966
Name:LOOP PLAZA PHARMACY CO
Entity type:Organization
Organization Name:LOOP PLAZA PHARMACY CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:STARRETT
Authorized Official - Last Name:MCFARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:304-727-2233
Mailing Address - Street 1:PO BOX 480
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-0480
Mailing Address - Country:US
Mailing Address - Phone:304-727-2233
Mailing Address - Fax:304-727-2299
Practice Address - Street 1:72 6TH AVE
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-2769
Practice Address - Country:US
Practice Address - Phone:304-727-2233
Practice Address - Fax:304-727-2299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0110103336C0004X, 3336I0012X, 3336N0007X, 3336H0001X, 3336S0011X, 3336L0003X, 3336C0002X, 333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336N0007XSuppliersPharmacyNuclear Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0143847000Medicaid
WV0143847000Medicaid