Organization
BYPASS PHARMACY INC
Active
Other names
BYPASS PHARMACY # 2
Organization subpart
No
Provider details
NPI number
Authorized official
SIDDARTHAN ILANGOVAN (PRESIDENT)
(304) 222-3064
Entity
Organization
Contact information
Practice address
725 RITTER DR FL 1, GLEN MORGAN, WV 25813-7709
(304) 252-3000
(304) 252-8212
Mailing address
104 S EISENHOWER DR, BECKLEY, WV 25801-4930
(304) 222-3064
(304) 253-3982
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
SP0552433
WV
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2136181
PK
—
Enumeration date
07/27/2012
Last updated
11/18/2021
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