Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
Other names
Community Care Pharmacy Of Green Bank
Organization subpart
No
Provider details
NPI number
Authorized official
DORA L POTASNIK (CREDENTIALING COORDINATOR)
(304) 317-7275
Entity
Organization
Contact information
Practice address
4498 POTOMAC HIGHLANDS TRIAL, GREEN BANK, WV 24944
(304) 456-3333
(304) 456-3070
Mailing address
4498 POTOMAC HIGHLANDS TRIAL, GREEN BANK, WV 24944
(304) 456-3333
(304) 456-3070
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MP0552572
PHARMACY LICENSE
WV
Enumeration date
08/05/2022
Last updated
08/05/2022
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