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General NPI Number Information
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NPI Number | 1083719314
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Entity Type | Organization
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Legal Business Name | WESTERN GREENBRIER PHARMACY INC
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 06/21/2016
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Provider Practice Location Address
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Address Line | 356 NICHOLAS ST.
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City | RUPERT
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State | WV
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Zip | 25984-0596
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Country | US
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Telephone | 304-392-6348
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Fax | 304-392-6350
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Provider Business Mailing Address
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Address Line | PO BOX 596
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City | RUPERT
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State | WV
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Zip | 25984-0596
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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 | OWNER
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Name | ROBERT WEED
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Credential | R.PH.
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Telephone | 304-392-6348
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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 | SP0550080
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License Number State | WV
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