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General NPI Number Information
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NPI Number | 1467703991
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Entity Type | Organization
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Legal Business Name | RX MEDICAL COMPOUNDING, LLC
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Dates
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Enumeration Date | 09/24/2012
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Last Update Date | 09/24/2012
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Provider Practice Location Address
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Address Line | 3159 ROBERT C BYRD DR
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City | BECKLEY
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State | WV
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Zip | 25801-3724
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Country | US
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Telephone | 304-255-6334
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Fax | 304-255-9011
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Provider Business Mailing Address
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Address Line | 3159 ROBERT C BYRD DR
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City | BECKLEY
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State | WV
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Zip | 25801-3724
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Country | US
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Telephone | 304-255-6334
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Fax | 304-255-9011
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL GERARD POWERS
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Credential |
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Telephone | 304-255-6334
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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 | SP0552432
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number | SP0552432
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | SP0552432
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License Number State | WV
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