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General NPI Number Information
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NPI Number | 1366429953
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Entity Type | Organization
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Legal Business Name | FAIRMOUNT FAMILY PHARMACY
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Dates
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Enumeration Date | 12/27/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1325 LOCUST AVENUE
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City | FAIRMOUNT
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State | WV
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Zip | 26554
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Country | US
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Telephone | 304-367-8600
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Fax | 304-367-8601
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Provider Business Mailing Address
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Address Line | 1325 LOCUST AVENUE
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City | FAIRMOUNT
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State | WV
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Zip | 26554
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Country | US
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Telephone | 304-367-8600
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Fax | 304-367-8601
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Authorized Official
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Title or Position | ASSISTANT VICE PRESIDENT
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Name | DR. KIMBERLY A CHEUVRONT
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Credential | PHD
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Telephone | 304-367-7488
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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 | MP0552253
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License Number State | WV
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