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General NPI Number Information
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NPI Number | 1437252574
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Entity Type | Organization
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Legal Business Name | PLEASANT VALLEY PHARMACY
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 07/15/2016
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Provider Practice Location Address
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Address Line | 49 VIP WAY
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City | FAIRMONT
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State | WV
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Zip | 26554
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Country | US
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Telephone | 304-366-3145
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Fax | 304-363-8485
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Provider Business Mailing Address
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Address Line | 49 VIP WAY
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City | FAIRMONT
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State | WV
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Zip | 26554
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Country | US
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Telephone | 304-366-3145
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Fax | 304-363-8485
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Authorized Official
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Title or Position | RX MANAGER
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Name | MARTIN HOFFMAN
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Credential | RPH
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Telephone | 304-363-0568
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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 | SP0552341
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License Number State | WV
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