Healthcare Provider Details

I. General information

NPI: 1003909227
Provider Name (Legal Business Name): CHARLIES PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 MAIN ST
PINEVILLE WV
24874
US

IV. Provider business mailing address

PO BOX 397
PINEVILLE WV
24874-0397
US

V. Phone/Fax

Practice location:
  • Phone: 304-732-6969
  • Fax: 304-732-6866
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberSP0551195
License Number StateWV

VIII. Authorized Official

Name: EVA BURNS
Title or Position: PRES
Credential: RPH
Phone: 304-732-6969