Van Pharmacy, Inc
Organization Active NPI Community/Retail Pharmacy · Van, WV
NPI 1215938121 · NPPES record last updated Jan 2, 2018
Key facts
- NPI
- 1215938121
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- VAN PHARMACY, INC
- Practice address
- 19024 Pond Fork Road
Van, WV 25206 - Phone
- (304) 245-8255
- Fax
- (304) 245-8133
- NPI assigned
- Aug 2, 2005
- Organization subpart
- No
Authorized official
- Name
- Mrs. Robin Anita Moore
- Title
- Owner
- Phone
- (304) 245-8255
Practitioners 1
-
Joey N Smith, RPH
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WV
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20131003000345 | WV | Part B Supplier - Mass Immunization (Roster Biller Only) | 7214053909 | Practice locations: Van, WV |
| O20171228000300 | WV | Part B Supplier - Mass Immunization (Roster Biller Only) | 2567720345 | Practice locations: Van, WV |
National Provider Directory
Locations
19024 Pond Fork Rd
Van, WV 25206
Phone (304) 245-8255
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
19024 Pond Fork Road
Van, WV 25206
Mailing address
19024 Pond Fork Road
PO Box 450
Van, WV 25206
Phone (304) 245-8255
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0139529000 | Medicaid | WV |
Other providers in Van, WV
- Cynthia McCarty Glenn
- Angela Michelle Jarrell
- Lincoln County Primary Care Center Inc
- Lincoln County Primary Care Center Inc
- Joey N Smith
- Danny White
All providers in Van, WV · Community/Retail Pharmacy in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 2, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.