Provider Demographics
NPI:1316958978
Name:STALEYS PHARMACIES
Entity type:Organization
Organization Name:STALEYS PHARMACIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:STALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-532-2546
Mailing Address - Street 1:PO BOX 79
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-0079
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2024 S 9TH ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-2455
Practice Address - Country:US
Practice Address - Phone:740-532-2546
Practice Address - Fax:740-532-8063
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STALEYS PHARMACIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-10
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
OH020133450333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9052911Medicaid
3622215OtherOTHER ID NUMBER-COMMERCIAL NUMBER