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Organization
KMART3425
Active
Organization
KMART3425
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY LEE BAKER PHARMACIST (STAFF PHARMACIST)
(606) 920-9933
Entity
Organization
Contact information
Practice address
5636 US ROUTE 60, HUNTINGTON, WV 25705-2148
(304) 736-2098
Mailing address
5636 US ROUTE 60, HUNTINGTON, WV 25705-2148
(304) 736-2098
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
RP0007348
WV
Other
Enumeration date
05/12/2015
Last updated
05/12/2015
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