Organization
UBC LATE STAGE INC
Active
Other names
UBC Late Stage, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
AMY MILLER PHARMD (DIRECTOR)
(304) 291-7524
Entity
Organization
Contact information
Practice address
200 PINECREST PLZ, MORGANTOWN, WV 26505-8065
(304) 291-7524
(304) 292-6391
Mailing address
200 PINECREST PLZ, MORGANTOWN, WV 26505-8065
(304) 291-7524
(304) 292-6391
Taxonomy
Speciality
Code
Description
License number
State
3336M0002X
Mail Order Pharmacy
Primary
MO0560083
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5055151
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
01/15/2010
Last updated
10/26/2012
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