Organization
CHARLIE'S PHARMACY OF MULLENS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN WILSON PHARM D (MANAGER)
(304) 294-5447
Entity
Organization
Contact information
Practice address
224 HOWARD AVE, MULLENS, WV 25882-1421
(304) 294-5447
(304) 294-5314
Mailing address
PO BOX 788, MULLENS, WV 25882-0788
(304) 294-5447
(304) 294-5314
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
552361
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810010896
—
WV
Enumeration date
10/23/2007
Last updated
10/21/2022
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