Provider Demographics
NPI:1548667819
Name:STULTZ PHARMACY OF WHEELERSBURG INC
Entity type:Organization
Organization Name:STULTZ PHARMACY OF WHEELERSBURG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/RPH
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:STULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:740-574-8933
Mailing Address - Street 1:8991 OHIO RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-1923
Mailing Address - Country:US
Mailing Address - Phone:740-574-8933
Mailing Address - Fax:740-981-3340
Practice Address - Street 1:8770 OHIO RIVER RD
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-1918
Practice Address - Country:US
Practice Address - Phone:740-574-8933
Practice Address - Fax:740-981-3340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0224657503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3682653OtherNCPDP
OH022465750OtherOHIO STATE LICENSE NUMBER
OH022465750OtherOHIO STATE LICENSE NUMBER