Healthcare Provider Details

I. General information

NPI: 1114361805
Provider Name (Legal Business Name): MOUNTAINEER DRUG INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 LEWIS STREET
WHITESVILLE WV
25209
US

IV. Provider business mailing address

4021 RIDGEVIEW LN OPTIONAL
HURRICANE WV
25526-1366
US

V. Phone/Fax

Practice location:
  • Phone: 304-854-7990
  • Fax:
Mailing address:
  • Phone: 304-767-1803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberSP0552450
License Number StateWV

VIII. Authorized Official

Name: DR. MEGAN SMARR
Title or Position: OWNER
Credential: PHARM.D.
Phone: 304-767-1803