Healthcare Provider Details

I. General information

NPI: 1164515599
Provider Name (Legal Business Name): CHARLIES PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 HOWARD AVE
MULLENS WV
25882-1421
US

IV. Provider business mailing address

PO BOX 788
MULLENS WV
25882-0788
US

V. Phone/Fax

Practice location:
  • Phone: 304-294-5447
  • Fax: 304-294-5314
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberSP0550878
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: EVA BURNS
Title or Position: PRES
Credential: RPH
Phone: 304-294-5447