Organization
COAL RIVER PHARMACY LLC
Active
Other names
FAMILY LIFE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE MASSEY (OWNER)
(304) 837-3777
Entity
Organization
Contact information
Practice address
21189 COAL RIVER RD, COMFORT, WV 25049
(304) 837-3777
(304) 837-3776
Mailing address
PO BOX 190, SETH, WV 25181-0190
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
SP0552365
WV
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2111653
PK
—
05
—
3810011065
—
WV
Enumeration date
01/02/2008
Last updated
04/13/2021
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