Organization
PETERSTOWN PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT KELLEY MASSIE JR. PHARMAIST (PRESIDENT)
(304) 753-5074
Entity
Organization
Contact information
Practice address
105 MARKET STREET, PETERSTOWN, WV 24963
(304) 753-5074
(304) 753-5078
Mailing address
PO BOX 338, PETERSTOWN, WV 24963-0338
(304) 753-5074
(304) 753-5078
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
SP0552221
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0141778000
—
WV
Enumeration date
05/19/2008
Last updated
06/06/2008
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