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General NPI Number Information
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NPI Number | 1033650098
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Entity Type | Organization
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Legal Business Name | COMMUNITY CARE PHARMACY OF WEST VIRGINIA INC
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Dates
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Enumeration Date | 03/10/2017
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 37 W MAIN ST
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City | BUCKHANNON
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State | WV
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Zip | 26201-2235
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Country | US
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Telephone | 304-472-1712
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Fax | 304-472-1715
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Provider Business Mailing Address
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Address Line | 37 W MAIN ST
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City | BUCKHANNON
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State | WV
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Zip | 26201-2235
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Country | US
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Telephone | 304-472-1712
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Fax | 304-472-1715
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Authorized Official
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Title or Position | CFO
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Name | CONNIE JOHNSTON
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Credential |
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Telephone | 304-924-6262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | MP0552427
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License Number State | WV
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