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General NPI Number Information
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NPI Number | 1497100762
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Entity Type | Organization
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Legal Business Name | MIKES BEST PRACTICES PHARMACY LLC
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Dates
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Enumeration Date | 04/25/2016
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Last Update Date | 08/12/2016
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Provider Practice Location Address
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Address Line | 710 W RIDGE RD SUITE A
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City | WYTHEVILLE
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State | VA
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Zip | 24382-1095
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Country | US
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Telephone | 276-335-2127
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Fax | 276-335-2102
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Provider Business Mailing Address
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Address Line | PO BOX 1318
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City | WYTHEVILLE
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State | VA
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Zip | 24382-8318
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Country | US
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Telephone | 276-335-2127
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Fax | 276-335-2102
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Authorized Official
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Title or Position | OWNER/PIC
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Name | MICHAEL CRADDOCK
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Credential |
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Telephone | 276-335-2153
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 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 #3
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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 #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 0201004698
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License Number State | VA
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