Provider Demographics
NPI:1932542420
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:
Authorized Official - Phone:740-981-3334
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:740-981-3334
Mailing Address - Fax:740-981-3340
Practice Address - Street 1:8991 OHIO RIVER RD
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-1923
Practice Address - Country:US
Practice Address - Phone:740-981-3334
Practice Address - Fax:740-981-3340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH022252400Medicaid
KY7100245570Medicaid
KY7100245570Medicaid
OHFS37929365OtherDEA