Healthcare Provider Details

I. General information

NPI: 1366515991
Provider Name (Legal Business Name): DANVILLE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 SMOOT AVE
DANVILLE WV
25053
US

IV. Provider business mailing address

PO BOX 462
DANVILLE WV
25053-0462
US

V. Phone/Fax

Practice location:
  • Phone: 304-369-3981
  • Fax: 304-269-3983
Mailing address:
  • Phone: 304-369-3981
  • Fax: 304-369-3983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberSP0552186
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHAD ALAN MOLES
Title or Position: OWNER
Credential: PHARM. D
Phone: 304-369-3981