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Organization
MEDICAL PARK PHARMACY LTC INC
Active
Organization
MEDICAL PARK PHARMACY LTC INC
Active
Other names
MEDICAL PARK PHARMACY LTC INC
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELE DILLON (OWNER/PRESIDENT)
(304) 654-2277
Entity
Organization
Contact information
Practice address
4118 5TH STREET RD, HUNTINGTON, WV 25701-9547
(304) 529-3784
(304) 529-3785
Mailing address
PO BOX 999, LAVALETTE, WV 25535-0999
(304) 654-2277
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
NRP022419250-03
OH
3336L0003X
Long Term Care Pharmacy
SP0552406
WV
3336L0003X
Long Term Care Pharmacy
Primary
WV1938
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2124436
PK
—
Enumeration date
03/11/2010
Last updated
07/29/2016
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