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General NPI Number Information
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NPI Number | 1003909227
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Entity Type | Organization
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Legal Business Name | CHARLIES PHARMACY INC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 02/01/2008
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Provider Practice Location Address
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Address Line | 233 MAIN ST
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City | PINEVILLE
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State | WV
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Zip | 24874
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Country | US
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Telephone | 304-732-6969
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Fax | 304-732-6866
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Provider Business Mailing Address
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Address Line | PO BOX 397
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City | PINEVILLE
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State | WV
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Zip | 24874-0397
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRES
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Name | EVA BURNS
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Credential | RPH
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Telephone | 304-732-6969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | SP0551195
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License Number State | WV
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