Mountaineer Medical Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

SP0552456 Issued in WV

Legal business name

MOUNTAINEER MEDICAL PHARMACY LLC

Practice address

120 Medical Park Dr Ste 102
Bridgeport, WV 26330-9013

Phone

(304) 423-5200

Fax

(304) 848-6050

NPI assigned

Jun 28, 2013

Organization subpart

No

Name

Michael Kovack

Title

Pharm MGR

Phone

(304) 423-5000

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Melissa Minigh

  • Pharmacist
  • Bridgeport, WV
  • NPI 1144659574
  NPD (past)

• MOUNTAINEER MEDICAL PHARMACY LLC Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 26, 2013.

{
    "created_epoch": "1372377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382745600000",
    "number": "1134569668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 MEDICAL PARK DR STE 102",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263309013",
            "telephone_number": "304-423-5200",
            "fax_number": "304-848-6050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 MEDICAL PARK DR STE 102",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263309013",
            "telephone_number": "304-423-5200",
            "fax_number": "304-848-6050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAINEER MEDICAL PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-28",
        "last_updated": "2013-10-26",
        "status": "A",
        "authorized_official_last_name": "KOVACK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PHARM MGR",
        "authorized_official_telephone_number": "304-423-5000"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WV",
            "license": "SP0552456",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2141915",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MOUNTAINEER MEDICAL PHARMACY LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mountain State Medical Specialties, PLLC
• Mountain State Medical Specialties,Inc.
• Mountainear Audiology & Hearing Aid Center, LLC
• Mountaineer Family Practice PLLC
• Mountaineer Medical Office Building Pharmacy
• Mountaineer Orthodontics, PLLC
• Mountainstate Infectious Disease, PLLC
• Khaldoun Mohamad Mozahem, MD
• Matthew Mullenax
• Megan Muncy, ARNP

• All providers in Bridgeport, WV
• Community/Retail Pharmacy in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2013; 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.