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General NPI Number Information
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NPI Number | 1386723062
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Entity Type | Organization
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Legal Business Name | CHARLESTON MEDICAL CENTER PHARMACY
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 04/07/2009
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Provider Practice Location Address
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Address Line | 3100 MACCORKLE AVE SE STE 100
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City | CHARLESTON
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State | WV
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Zip | 25304-1223
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Country | US
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Telephone | 304-344-8021
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Fax | 304-344-0655
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Provider Business Mailing Address
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Address Line | 3100 MACCORKLE AVE SE STE 100
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City | CHARLESTON
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State | WV
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Zip | 25304-1223
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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 | PHARM
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Name | JAMES BARTSCH
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Credential | RPH
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Telephone | 304-344-8021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding 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 | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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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 #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | SP0550648
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License Number State | WV
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