Healthcare Provider Details

I. General information

NPI: 1285751586
Provider Name (Legal Business Name): MCDOWELL PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT 16 MAIN ST
WAR WV
24892
US

IV. Provider business mailing address

104 CIRCLE DR
PRINCETON WV
24740-2510
US

V. Phone/Fax

Practice location:
  • Phone: 304-875-2291
  • Fax: 304-875-2292
Mailing address:
  • Phone: 304-875-2291
  • Fax: 304-875-2292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberSP0552355
License Number StateWV

VIII. Authorized Official

Name: ROBERT BROWN
Title or Position: PRESIDENT
Credential: PHRMD
Phone: 304-425-5093