Main Street Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

MAIN STREET PHARMACY INC

Practice address

4501 Maccorkle Ave SW Ste 101
South Charleston, WV 25309-1444

Phone

(304) 766-8484

Fax

(304) 766-8344

NPI assigned

Dec 14, 2021

Organization subpart

Yes

Parent organization

MAIN STREET PHARMACY, INC.As reported in NPPES

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

Authorized official

Name

Carol A Jones

Title

Manager

Phone

(304) 465-7200

Specialties & licenses 1

Addresses

Other names 1

• Clark's Family Pharmacy Inc. Doing business as

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Main Street Pharmacy, Inc.

  • Pharmacy
  • Oak Hill, WV
  • NPI 1033169420

  4880705789

  Same PAC ID

Part of

Main Street Pharmacy Inc

Locations

Practitioners 2

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

• Robin Lynn Chianumba, FNP

  • Family Nurse Practitioner
  • Beckley, WV
  • NPI 1427142660
  NPD (past)
• Mohammad Anwar Ullah, MD

  • Family Medicine Physician
  • Oak Hill, WV
  • NPI 1285697326
  NPD (past)

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

{
    "created_epoch": "1639440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639440000000",
    "number": "1306505763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4501 MACCORKLE AVE SW STE 101",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091444",
            "telephone_number": "304-766-8484",
            "fax_number": "304-766-8344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4501 MACCORKLE AVE SW STE 101",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091444",
            "telephone_number": "304-766-8484",
            "fax_number": "304-766-8344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET PHARMACY INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MAIN STREET PHARMACY, INC.",
        "enumeration_date": "2021-12-14",
        "last_updated": "2021-12-14",
        "certification_date": "2021-12-10",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "304-465-7200"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clark's Family Pharmacy Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Haylie Maciel, CRNA
• Barbara Mackenzie
• Lewanda Macklin
• Hannah Isabel Magee
• Maia, LLC
• Melissa Maker
• Amy Malcomb
• Barbara Jo Mallory
• Brooke Naomi Mallory
• Lisa R Mallory, AGNP-C

• Community/Retail Pharmacy in South Charleston, WV
• Providers in South Charleston, WV by specialty
• Community/Retail Pharmacy in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2021; 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.

Verify at the official NPI Registry.