Healthcare Provider Details

I. General information

NPI: 1285793281
Provider Name (Legal Business Name): LOOP PLAZA PHARMACY CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4918 MACCORKLE AVE SE
CHARLESTON WV
25304-2052
US

IV. Provider business mailing address

PO BOX 480
SAINT ALBANS WV
25177-0480
US

V. Phone/Fax

Practice location:
  • Phone: 304-720-7866
  • Fax: 304-720-7868
Mailing address:
  • Phone: 304-722-2233
  • Fax: 304-727-2299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberMP0550920
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM MCFARLAND
Title or Position: OWNER
Credential: RPH
Phone: 304-720-7867