Organization
LINCOLN COUNTY PRIMARY CARE CENTER INC
Active
Other names
MADISON MEDICAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
LETITIA ANN WEAVER (CREDENTIALING COORDINATOR)
(304) 824-5806
Entity
Organization
Contact information
Practice address
471 MAIN ST, MADISON, WV 25130-1223
(304) 807-9208
Mailing address
7400 LYNN AVE, HAMLIN, WV 25523-1138
(304) 824-5806
(304) 824-5885
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2362-7476
LICENSE
WV
Enumeration date
01/02/2019
Last updated
12/10/2024
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