Organization
VAN PHARMACY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROBIN ANITA MOORE (OWNER)
(304) 245-8255
Entity
Organization
Contact information
Practice address
19024 POND FORK ROAD, VAN, WV 25206
(304) 245-8255
(304) 245-8133
Mailing address
19024 POND FORK ROAD, PO BOX 450, VAN, WV 25206
(304) 245-8255
(304) 245-8133
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0139529000
—
WV
Enumeration date
08/02/2005
Last updated
01/02/2018
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