Healthcare Provider Details

I. General information

NPI: 1609931732
Provider Name (Legal Business Name): CLENDENIN PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MAIN ST
CLENDENIN WV
25045
US

IV. Provider business mailing address

PO BOX 698
CLENDENIN WV
25045-0698
US

V. Phone/Fax

Practice location:
  • Phone: 304-548-5451
  • Fax: 304-548-5765
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberSP0550759
License Number StateWV

VIII. Authorized Official

Name: WILLIAM ORE
Title or Position: PRES
Credential: RPH
Phone: 304-548-5451