Provider Demographics
NPI:1447919196
Name:PPADWVL LLC
Entity type:Organization
Organization Name:PPADWVL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:STOKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:828-575-6421
Mailing Address - Street 1:3 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-9427
Mailing Address - Country:US
Mailing Address - Phone:828-713-9626
Mailing Address - Fax:828-484-8956
Practice Address - Street 1:3 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-9427
Practice Address - Country:US
Practice Address - Phone:828-713-9626
Practice Address - Fax:828-484-8956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty