Organization
COMMUNITY CARE OF WEST VIRGINIA
Active
Other names
Primary Care Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CONNIE JOHNSTON (CFO)
(304) 924-6262
Entity
Organization
Contact information
Practice address
122 CENTER ST, CLAY, WV 25043-7046
(304) 587-4555
(304) 587-4584
Mailing address
PO BOX 217, ROCK CAVE, WV 26234-0217
(304) 471-2250
(304) 924-6891
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
SP0552399
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2123802
PK
—
Enumeration date
02/12/2010
Last updated
07/19/2018
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