Organization
GAULEY RIVER PHARMACY INC
Active
Other names
Gauley River Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
HOWARD BOONE BS (PRESIDENT)
(304) 742-5001
Entity
Organization
Contact information
Practice address
433 CRAIGSVILLE RD, SUITE 2, CRAIGSVILLE, WV 26205
(304) 742-5001
(304) 742-5002
Mailing address
PO BOX 962, CRAIGSVILLE, WV 26205-0962
(304) 742-5001
(304) 742-5002
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
SP0552388
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2118314
PK
—
05
—
3810014316
—
WV
Enumeration date
01/02/2009
Last updated
06/11/2015
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