# JOHN MANCHIN III

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MANCHIN FAMILY PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689849804
- **Authorized official:** JOHN MANCHIN III B.S. (OWNER)
- **Authorized official phone:** (304) 367-9122

## Contact information

- **Practice address:** 181 MIDDLETOWN CIR, FAIRMONT, WV 26554-2015
- **Practice address phone:** (304) 367-9122
- **Practice address fax:** (304) 367-9125
- **Mailing address:** 181 MIDDLETOWN CIR, FAIRMONT, WV 26554-2015
- **Mailing address phone:** (304) 367-9122
- **Mailing address fax:** (304) 367-9125

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0002X | Clinic Pharmacy | SP0552377 | WV | Yes |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 04/29/2008
- **Last updated:** 04/25/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2111736 | PK | — |
| 05 | — | 3810011348 | — | WV |