Healthcare Provider Details

I. General information

NPI: 1477646693
Provider Name (Legal Business Name): PENDLETON COMMUNITY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 N MAIN STREET
FRANKLIN WV
26807
US

IV. Provider business mailing address

PO BOX 189
FRANKLIN WV
26807-0189
US

V. Phone/Fax

Practice location:
  • Phone: 304-358-2887
  • Fax: 304-358-3149
Mailing address:
  • Phone: 304-358-2887
  • Fax: 304-358-3149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberSP0552383
License Number StateWV

VIII. Authorized Official

Name: JAMIE HUDSON
Title or Position: CEO
Credential: RPH
Phone: 304-358-2355