Healthcare Provider Details

I. General information

NPI: 1356007629
Provider Name (Legal Business Name): MEDICINE CABINET LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 11/11/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 LINCOLN STREET
KERMIT WV
25674-2567
US

IV. Provider business mailing address

PO BOX 600
KERMIT WV
25674-0600
US

V. Phone/Fax

Practice location:
  • Phone: 304-393-3386
  • Fax: 304-393-3387
Mailing address:
  • Phone: 304-393-3386
  • Fax: 304-393-3387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State

VIII. Authorized Official

Name: LARRY E BARTOE
Title or Position: OWNER
Credential: RPH
Phone: 304-393-3386