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General NPI Number Information
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NPI Number | 1992344568
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Entity Type | Organization
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Legal Business Name | MOUNTAIN VALLEY LLC
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Dates
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Enumeration Date | 12/31/2019
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Last Update Date | 12/31/2019
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Provider Practice Location Address
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Address Line | 827 FAIRMONT RD STE 104
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City | MORGANTOWN
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State | WV
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Zip | 26501-3857
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Country | US
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Telephone | 304-943-7177
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Fax |
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Provider Business Mailing Address
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Address Line | 827 FAIRMONT RD STE 104
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City | MORGANTOWN
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State | WV
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Zip | 26501-3857
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | GULBADAN SINGH
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Credential |
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Telephone | 304-943-7177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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