Organization
JOHN MANCHIN III
Active
Other names
THE DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN MANCHIN B.S. (OWNER)
(304) 825-6554
Entity
Organization
Contact information
Practice address
1021 MAIN ST, FARMINGTON, WV 26571
(304) 825-1270
(304) 825-1196
Mailing address
PO BOX 597, FARMINGTON, WV 26571-0597
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
SPO552200
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0141691000
—
WV
01
—
2111318
PK
—
Enumeration date
10/25/2006
Last updated
07/22/2014
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