Organization
COUNTRY ROADS PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERESA CELENE THOMPSON R.PH. (REGISTERED PHARMACIST)
(304) 934-5327
Entity
Organization
Contact information
Practice address
109 BOLT RD, GLEN DANIEL, WV 25844-0000
(304) 934-5327
(304) 934-5328
Mailing address
PO BOX 460, GLEN DANIEL, WV 25844-0460
(304) 934-5327
(304) 934-5328
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
SP0550106
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0139243000
—
WV
Enumeration date
11/27/2006
Last updated
02/24/2014
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