Healthcare Provider Details

I. General information

NPI: 1730012964
Provider Name (Legal Business Name): PRESTIGE PHARMACY L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 STANAFORD RD
BECKLEY WV
25801-3145
US

IV. Provider business mailing address

455 STANAFORD RD
BECKLEY WV
25801-3145
US

V. Phone/Fax

Practice location:
  • Phone: 304-250-8922
  • Fax:
Mailing address:
  • Phone: 304-250-8922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. KHAJA MOHAMMED
Title or Position: PHARMACIST
Credential: RPH
Phone: 304-250-8922