Healthcare Provider Details

I. General information

NPI: 1104884535
Provider Name (Legal Business Name): BECKLEY VAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 VETERANS AVENUE
BECKLEY WV
25801-6444
US

IV. Provider business mailing address

PO BOX 89428
CLEVELAND OH
44101-6428
US

V. Phone/Fax

Practice location:
  • Phone: 304-255-2121
  • Fax: 304-256-5456
Mailing address:
  • Phone: 828-257-2333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332100000X
TaxonomyDepartment of Veterans Affairs (VA) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ERIN DENISE POTTER
Title or Position: NPI TEAM MEMBER
Credential:
Phone: 202-382-2579