Organization
CREIGHTON CORPORATION
Active
Other names
Moundsville IGA Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD MOLLENKOPF (MANAGER)
(304) 612-3115
Entity
Organization
Contact information
Practice address
200 LAFAYETTE AVE, MOUNDSVILLE, WV 26041-1001
(304) 843-0040
Mailing address
200 LAFAYETTE AVE, MOUNDSVILLE, WV 26041-1001
(304) 843-0040
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
MP0552345
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NCPDP
NCPDP
WV
Enumeration date
04/24/2007
Last updated
03/24/2008
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