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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