Healthcare Provider Details

I. General information

NPI: 1790867570
Provider Name (Legal Business Name): PHARMACOLE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 LAFAYETTE AVE
MOUNDSVILLE WV
26041-1029
US

IV. Provider business mailing address

118 LAFAYETTE AVE
MOUNDSVILLE WV
26041-1029
US

V. Phone/Fax

Practice location:
  • Phone: 304-845-0390
  • Fax: 304-845-0391
Mailing address:
  • Phone: 304-845-0390
  • Fax: 304-845-0391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberSP0550787
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberNRP.022335850-03
License Number StateOH

VIII. Authorized Official

Name: JASON TURNER
Title or Position: OWNER, PIC
Credential: PHARMD
Phone: 304-845-0390