Organization
MEDICAL PARK PHARMACY LTC INC
Active
Other names
MEDICAL PARK PHARMACY LTC INC
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELE DILLON (OWNER/PRESIDENT)
(304) 654-2277
Entity
Organization
Contact information
Practice address
4118 5TH STREET RD, HUNTINGTON, WV 25701-9547
(304) 529-3784
(304) 529-3785
Mailing address
PO BOX 999, LAVALETTE, WV 25535-0999
(304) 654-2277
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
NRP022419250-03
OH
3336L0003X
Long Term Care Pharmacy
SP0552406
WV
3336L0003X
Long Term Care Pharmacy
Primary
WV1938
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2124436
PK
—
Enumeration date
03/11/2010
Last updated
07/29/2016
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