Organization
BLACK DIAMOND PHARMACY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID HENRY DUNSON R.PH., CDE (OWNER,MANAGER)
(304) 862-2105
Entity
Organization
Contact information
Practice address
33800 COAL HERITAGE ROAD, NORTHFORK, WV 24868-0397
(304) 862-2105
(304) 862-2107
Mailing address
PO BOX 397, NORTHFORK, WV 24868-0397
(304) 862-2105
(304) 862-2107
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
SP552244
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0008503000
—
WV
01
—
5011438
NABP
WV
Enumeration date
10/20/2006
Last updated
03/07/2023
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