| NPI | 1659358513 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN MARK ELLISON Pharmacist Manager 304-466-2323 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: WV SP0550015) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: WV SP0550015) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2020-08-22 |