Healthcare Provider Details

I. General information

NPI: 1235238122
Provider Name (Legal Business Name): RAINELLE MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 MEDICAL CENTER DR
RAINELLE WV
25962-1064
US

IV. Provider business mailing address

176 MEDICAL CENTER DR
RAINELLE WV
25962-1064
US

V. Phone/Fax

Practice location:
  • Phone: 304-438-6186
  • Fax: 304-438-6185
Mailing address:
  • Phone: 304-438-6186
  • Fax: 304-438-6185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberSP0551235
License Number StateWV

VIII. Authorized Official

Name: DAVID YOAKUM
Title or Position: DIRECTOR OF PHARMACY
Credential: PHARMD, CDE
Phone: 304-438-6188