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General NPI Number Information
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NPI Number | 1487944377
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Entity Type | Organization
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Legal Business Name | PHARMCORX LLC
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Dates
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Enumeration Date | 04/12/2011
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Last Update Date | 04/19/2011
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Provider Practice Location Address
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Address Line | 164 THOMPSON DR SUITE 25
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City | BRIDGEPORT
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State | WV
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Zip | 26330-1644
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Country | US
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Telephone | 304-933-3353
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Fax | 304-933-3354
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Provider Business Mailing Address
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Address Line | 164 THOMPSON DR SUITE 25
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City | BRIDGEPORT
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State | WV
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Zip | 26330-1644
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Country | US
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Telephone | 304-933-3353
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Fax | 304-933-3354
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Authorized Official
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Title or Position | MANAGER
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Name | MR. MATTHEW A GENIN
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Credential | PHARMACIST
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Telephone | 304-933-3353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP0006332
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License Number State | WV
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