Organization
MED-MART PHARMACY LLC
Active
Other names
MED-MART PHARMACY FAIRMONT
Organization subpart
No
Provider details
NPI number
Authorized official
IBRAHIM KADDOURAH (OWNER/PIC)
(304) 367-9122
Entity
Organization
Contact information
Practice address
181 MIDDLETOWN CIR, FAIRMONT, WV 26554-2015
(304) 367-9122
(304) 367-9125
Mailing address
2524 SUN TRL, MORGANTOWN, WV 26505-1131
(304) 690-6165
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
SP0552522
WV
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2176926
PK
—
Enumeration date
04/18/2018
Last updated
12/11/2019
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