Organization
CUSTOM SCRIPT INFUSION VITAL CARE LLC
Active
Other names
CUSTOM SCRIPT PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
NICK HOPKINS (PHARMACIST IN CHARGE)
(304) 733-3784
Entity
Organization
Contact information
Practice address
3738 TEAYS VALLEY RD, SUITE C, HURRICANE, WV 25526-9705
(304) 733-3784
(304) 733-1398
Mailing address
PO BOX 361, CLEARFIELD, KY 40313-0361
(606) 780-0009
(606) 780-0167
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
SP0552452
WV
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2123986
PK
—
Enumeration date
03/02/2010
Last updated
04/13/2016
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