NPIMap

Organization Active NPI

Broadway Clinic Pharmacy Inc

Doing business as Medicine Cabinet Pharmacy

  • Community/Retail Pharmacy
  • Kermit, WV
National Provider Identifier
1043589062
Registry record updated Dec 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
MP0552396 Issued in WV
Legal business name
BROADWAY CLINIC PHARMACY INC
Doing business as
Medicine Cabinet Pharmacy
Practice address
50 Lincoln St
Kermit, WV 25674
Phone
(304) 393-3386
Fax
(304) 393-3387
NPI assigned
Dec 20, 2011
Last updated
Dec 20, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Steve Williams
Title
President
Phone
(606) 253-1266

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X MP0552396 WV Primary

Addresses

Primary practice location

50 Lincoln St
Kermit, WV 25674

Mailing address

50 Lincoln St
Kermit, WV 25674
Phone (304) 393-3386

Other identifiers 1

IdentifierTypeStateIssuer
5055618OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • MEDICINE CABINET PHARMACY Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1324339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324339200000",
    "number": "1043589062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 LINCOLN ST",
            "city": "KERMIT",
            "state": "WV",
            "postal_code": "25674",
            "telephone_number": "304-393-3386",
            "fax_number": "304-393-3387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 LINCOLN ST",
            "city": "KERMIT",
            "state": "WV",
            "postal_code": "25674",
            "telephone_number": "304-393-3386",
            "fax_number": "304-393-3387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY CLINIC PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-20",
        "last_updated": "2011-12-20",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "606-253-1266"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WV",
            "license": "MP0552396",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5055618",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICINE CABINET PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kermit, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.