Healthcare Provider Details

I. General information

NPI: 1609324284
Provider Name (Legal Business Name): APEX PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 RAGLAND RD
BECKLEY WV
25801-9763
US

IV. Provider business mailing address

165 RAGLAND RD
BECKLEY WV
25801-9763
US

V. Phone/Fax

Practice location:
  • Phone: 681-207-7334
  • Fax: 681-207-7338
Mailing address:
  • Phone: 681-207-7334
  • Fax: 681-207-7338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberOP0552223
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BOB KIBLINGER
Title or Position: OWNER/PIC
Credential:
Phone: 681-207-7334