MEDICARE: CHARLES TOWN PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy

General Provider Information

NPI Number	:	1225775141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES TOWN PHARMACY

Provider Business Mailing Address
First Line	:	231 N SAMUEL ST
Second Line	:
City	:	CHARLES TOWN
State	:	WV
Zip	:	25414-1839
Country	:	US
Telephone Number	:	571-289-7664
Fax Number	:

Provider Business Practice Location Address
First Line	:	231 N SAMUEL ST
Second Line	:
City	:	CHARLES TOWN
State	:	WV
Zip	:	25414-1839
Country	:	US
Telephone Number	:	571-289-7664
Fax Number	:

Authorized Official
Title or Position	:	PHARMACY MANGER
Name	:	EVON YOUSSEF
Credential	:
Telephone Number	:	571-289-7664

Provider Enumeration Date	:	05/13/2022
Last Update Date	:	05/13/2022

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