Healthcare Provider Details

I. General information

NPI: 1447591581
Provider Name (Legal Business Name): PENDLETON COMMUNITY CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MOTT STREET
HARMAN WV
26270-0000
US

IV. Provider business mailing address

PO DRAWER 14
HARMAN WV
26270-0014
US

V. Phone/Fax

Practice location:
  • Phone: 304-227-3661
  • Fax:
Mailing address:
  • Phone: 304-227-3661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

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