# CREIGHTON CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Moundsville IGA Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417176041
- **Authorized official:** MR. RICHARD MOLLENKOPF (MANAGER)
- **Authorized official phone:** (304) 612-3115

## Contact information

- **Practice address:** 200 LAFAYETTE AVE, MOUNDSVILLE, WV 26041-1001
- **Practice address phone:** (304) 843-0040
- **Mailing address:** 200 LAFAYETTE AVE, MOUNDSVILLE, WV 26041-1001
- **Mailing address phone:** (304) 843-0040

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | MP0552345 | WV | Yes |

## Other

- **Enumeration date:** 04/24/2007
- **Last updated:** 03/24/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | NCPDP | NCPDP | WV |