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Organization

BP4 LLC

Active
Other names
BYPASS PHARMACY # 4
Organization subpart
No

Provider details

NPI number
Authorized official
SIDDARTHAN ILANGOVAN (PHARMACIST)
(304) 222-3064
Entity
Organization

Contact information

Practice address
5151 MACCORKLE AVE SW, SOUTH CHARLESTON, WV 25309-1109
(304) 766-0900
(304) 766-0901
Mailing address
104 S EISENHOWER DR, BECKLEY, WV 25801-4930
(304) 222-3064
(304) 253-3982

Taxonomy

Speciality
Code
Description
License number
State
333600000X
Pharmacy
3336C0003X
Community/Retail Pharmacy
Primary
MP0552418
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2153688
PK
Enumeration date
08/25/2015
Last updated
11/18/2021
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