| NPI | 1972146314 |
|---|---|
| Doing Business As | SHADY SPRING PHARMACY |
| Entity Type | Organization |
| Authorized Contact | LESLIE DIANE SISSON Co Owner 304-573-1114 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2019-10-17 |
| Last Update Date | 2019-10-17 |