Organization
JERRY SKEENES
Active
Other names
ALUM CREEK PHARMACY AT SAND PLANT
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY SKEENES (OWNER)
(304) 756-2181
Entity
Organization
Contact information
Practice address
1563 SAND PLANT RD, SOUTH CHARLESTON, WV 25309-6120
(304) 756-2181
(304) 756-2796
Mailing address
PO BOX 37, ALUM CREEK, WV 25003-0037
(304) 756-2181
(304) 756-2796
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
SP0552446
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
139035000
—
WV
01
—
5001261
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/06/2006
Last updated
03/25/2013
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