Active NPI
Van Pharmacy, Inc
- Community/Retail Pharmacy
- Van, WV
National Provider Identifier
1215938121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- 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
- Last updated
- Jan 2, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Robin Anita Moore
- Title
- Owner
- Phone
- (304) 245-8255
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Primary |
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
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
Enrollment records 2
| 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
National Provider DirectoryLocations
19024 Pond Fork Rd
Van, WV 25206
Phone (304) 245-8255
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pharmacist
- Van, WV
- NPI 1235633603
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1122940800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1514851200000",
"number": "1215938121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19024 POND FORK ROAD",
"address_2": "PO BOX 450",
"city": "VAN",
"state": "WV",
"postal_code": "25206",
"telephone_number": "304-245-8255",
"fax_number": "304-245-8133"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19024 POND FORK ROAD",
"city": "VAN",
"state": "WV",
"postal_code": "25206",
"telephone_number": "304-245-8255",
"fax_number": "304-245-8133"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "VAN PHARMACY, INC",
"organizational_subpart": "NO",
"enumeration_date": "2005-08-02",
"last_updated": "2018-01-02",
"status": "A",
"authorized_official_last_name": "MOORE",
"authorized_official_first_name": "ROBIN",
"authorized_official_middle_name": "ANITA",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "304-245-8255",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Van, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.