Healthcare Provider Details

I. General information

NPI: 1407996382
Provider Name (Legal Business Name): WARDENSVILLE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17978 SR 55
BAKER WV
26801
US

IV. Provider business mailing address

PO BOX 31
BAKER WV
26801-0031
US

V. Phone/Fax

Practice location:
  • Phone: 304-897-8220
  • Fax: 304-897-8210
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberSP0552316
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LISA WHETZEL
Title or Position: OWNER PHARMACIST
Credential:
Phone: 304-874-3687