Organization
LUMBERPORT PHARMACY, INC
Active
Other names
Lumberport Pharmacy, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN COLER (OWNER/MANAGER/AO)
(740) 452-7685
Entity
Organization
Contact information
Practice address
308 MAIN STREET, LUMBERPORT, WV 26386
(740) 452-7655
(740) 452-7655
Mailing address
PO BOX 3506, ZANESVILLE, OH 43702-3506
(740) 452-7685
(740) 452-7665
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
MP0552539
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1326034141
—
WV
01
—
Q620870001
MEDICARE
—
Enumeration date
09/27/2005
Last updated
04/02/2020
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