Organization
CHARLESTON MEDICAL CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN PETTS PHARMD (DIRECTOR OF AMBULATORY SERVICES, AO)
(304) 388-7400
Entity
Organization
Contact information
Practice address
3415 MACCORKLE AVE SE APT EVE, CHARLESTON, WV 25304-1334
(304) 388-9700
(304) 388-9795
Mailing address
3415 MACCORKLE AVE SE APT EVE, CHARLESTON, WV 25304-1334
(304) 388-9700
(304) 388-9795
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
MP0552417
WV
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2149740
PK
—
05
—
3910007155
—
WV
Enumeration date
01/14/2015
Last updated
05/17/2018
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