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NPI 1194820977

NPI 1194820977 : CLARKS PHCY OF SALTVILLE INC : SALTVILLE, VA

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General NPI Number Information
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    NPI Number           |    1194820977
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    Entity Type          |    Organization 
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    Legal Business Name  |    CLARKS PHCY OF SALTVILLE INC 
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Dates
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    Enumeration Date     |    09/14/2006
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    Last Update Date     |    09/11/2025
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Provider Practice Location Address
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    Address Line         |    343 PALMER AVE 
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    City                 |    SALTVILLE
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    State                |    VA
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    Zip                  |    24370
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    Country              |    US
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    Telephone            |    276-496-7211
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    Fax                  |    276-496-5005
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Provider Business Mailing Address
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    Address Line         |    PO BOX S 
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    City                 |    SALTVILLE
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    State                |    VA
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    Zip                  |    24370-1149
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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                 |     STEVEN  HYLTON 
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    Credential           |    
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    Telephone            |    276-496-7211
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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       |    
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    License Number State |    
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Taxonomy #2
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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 |    VA
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