Organization
CUSTOM SCRIPT PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHAN BEAVER RRT (RESPIRATORY THERAPIST)
13047333784
Entity
Organization
Contact information
Practice address
3738 TEAYS VALLEY RD STE C, HURRICANE, WV 25526-9705
(130) 473-3378
(130) 473-3139
Mailing address
3738 TEAYS VALLEY RD STE C, HURRICANE, WV 25526-9705
(130) 473-3378
(130) 473-3139
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
WV
Other
Enumeration date
09/16/2014
Last updated
09/16/2014
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