Healthcare Provider Details

I. General information

NPI: 1801935242
Provider Name (Legal Business Name): CAMDEN ON GAULEY MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 03/07/2023
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10003 WEBSTER RD.
CAMDEN ON GAULEY WV
26208-0069
US

IV. Provider business mailing address

PO BOX 69
CAMDEN ON GAULEY WV
26208-0069
US

V. Phone/Fax

Practice location:
  • Phone: 304-226-5725
  • Fax: 304-226-3274
Mailing address:
  • Phone: 304-226-5725
  • Fax: 304-226-3274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0005879
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberSP0550588
License Number StateWV

VIII. Authorized Official

Name: MARGARET HICKEY
Title or Position: CEO
Credential:
Phone: 304-226-5725