Healthcare Provider Details

I. General information

NPI: 1831163906
Provider Name (Legal Business Name): LINCOLN COUNTY PRIMARY CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 LYNN AVE
HAMLIN WV
25523-1138
US

IV. Provider business mailing address

7400 LYNN AVE
HAMLIN WV
25523-1138
US

V. Phone/Fax

Practice location:
  • Phone: 304-824-6337
  • Fax: 304-824-6333
Mailing address:
  • Phone: 304-824-6337
  • Fax: 304-824-6333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberSP0552327
License Number StateWV

VIII. Authorized Official

Name: LISA LEACH
Title or Position: CEO
Credential: RPH., PHARM. D.
Phone: 304-824-5806