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General NPI Number Information
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NPI Number | 1417176041
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Entity Type | Organization
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Legal Business Name | CREIGHTON CORPORATION
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 03/24/2008
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Provider Practice Location Address
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Address Line | 200 LAFAYETTE AVE
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City | MOUNDSVILLE
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State | WV
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Zip | 26041-1001
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Country | US
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Telephone | 304-843-0040
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Fax |
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Provider Business Mailing Address
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Address Line | 200 LAFAYETTE AVE
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City | MOUNDSVILLE
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State | WV
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Zip | 26041-1001
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Country | US
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Telephone | 304-843-0040
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. RICHARD MOLLENKOPF
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Credential |
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Telephone | 304-612-3115
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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 | MP0552345
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License Number State | WV
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