Healthcare Provider Details

I. General information

NPI: 1609620855
Provider Name (Legal Business Name): CHARLESTON INFUSION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260A GREENBRIER ST
CHARLESTON WV
25311-1002
US

IV. Provider business mailing address

1260A GREENBRIER ST
CHARLESTON WV
25311-1002
US

V. Phone/Fax

Practice location:
  • Phone: 304-241-2340
  • Fax: 681-238-2386
Mailing address:
  • Phone: 304-241-2340
  • Fax: 681-238-2386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRAD GILCHRIST
Title or Position: PHARMACY MANAGER
Credential:
Phone: 601-482-4003