Organization
BROADWAY CLINIC PHARMACY INC
Active
Other names
MEDICINE CABINET PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE WILLIAMS (PRESIDENT)
(606) 253-1266
Entity
Organization
Contact information
Practice address
50 LINCOLN ST, KERMIT, WV 25674
(304) 393-3386
(304) 393-3387
Mailing address
50 LINCOLN ST, KERMIT, WV 25674
(304) 393-3386
(304) 393-3387
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
MP0552396
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5055618
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/20/2011
Last updated
12/20/2011
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