Organization
CUSTOM SCRIPT INFUSION VITAL CARE LLC
Active
Other names
Custom Script Infusion Vital Care
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD A WALLACE R.PH. (VP OPERATIONS)
(304) 543-3292
Entity
Organization
Contact information
Practice address
3738 TEAYS VALLEY RD, SUITE B, HURRICANE, WV 25526-9705
(304) 543-3292
Mailing address
3738 TEAYS VALLEY RD, SUITE B, HURRICANE, WV 25526-9705
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
MP0552402
WV
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
MP0552402
WV
333600000X
Pharmacy
MP0552402
WV
3336H0001X
Home Infusion Therapy Pharmacy
MP0552402
WV
3336L0003X
Long Term Care Pharmacy
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Other
Enumeration date
03/25/2013
Last updated
12/08/2014
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