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General NPI Number Information
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NPI Number | 1891890125
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Entity Type | Organization
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Legal Business Name | MED FAST PHARMACY LLC
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 1311 OLD COURTHOUSE SQ
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City | MARTINSBURG
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State | WV
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Zip | 25404
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Country | US
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Telephone | 304-264-0300
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Fax | 304-264-0224
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Provider Business Mailing Address
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Address Line | 1311 EDWIN MILLER BLVD
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City | MARTINSBURG
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State | WV
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Zip | 25404-3703
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Country | US
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Telephone | 304-264-0300
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Fax | 304-264-0224
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANTHONY MOORE
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Credential | RPH
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Telephone | 304-264-0300
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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 | MP0552313
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License Number State | WV
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