Organization
BROADWAY CLINIC PHARMACY INC
Active
Other names
MEDICINE CABINET PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE WILLIAMS (PRESIDENT)
(606) 324-6337
Entity
Organization
Contact information
Practice address
47454 ROUTE 52, KERMIT, WV 25674-8052
(304) 393-6905
(304) 393-6907
Mailing address
47454 ROUTE 52, KERMIT, WV 25674-8052
(304) 393-6905
(304) 393-6907
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
MP0552389
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5055290
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/15/2010
Last updated
01/25/2011
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