Organization
MOUNTAINEER MEDICAL OFFICE BUILDING PHARMACY
Active
Other names
Mountaineer Medical Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES BRADLEY FRANZ (PHYSICIAN MEMBER OF LLC)
(304) 624-7200
Entity
Organization
Contact information
Practice address
120 MEDICAL PARK DR STE 102, BRIDGEPORT, WV 26330-9013
(304) 423-5200
(304) 848-6050
Mailing address
120 MEDICAL PARK DR, SUITE 102, BRIDGEPORT, WV 26330-9012
(304) 423-5200
(304) 848-6050
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
SP0552423
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2132729
PK
—
05
—
3810022200
—
WV
Enumeration date
10/27/2011
Last updated
06/13/2013
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