Med-Mart Pharmacy LLC

Primary specialty

PharmacyTaxonomy code 333600000X

License

SP0552522 Issued in WV

Legal business name

MED-MART PHARMACY LLC

Doing business as

Med-Mart Pharmacy Fairmont

Practice address

181 Middletown Cir
Fairmont, WV 26554-2015

Phone

(304) 367-9122

Fax

(304) 367-9125

NPI assigned

Apr 18, 2018

Last updated

Dec 11, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ibrahim Kaddourah

Title

Owner/Pic

Phone

(304) 367-9122

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• MED-MART PHARMACY FAIRMONT Doing business as

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

{
    "created_epoch": "1524009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576022400000",
    "number": "1386131050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2524 SUN TRL",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265051131",
            "telephone_number": "304-690-6165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "181 MIDDLETOWN CIR",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265542015",
            "telephone_number": "304-367-9122",
            "fax_number": "304-367-9125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED-MART PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-18",
        "last_updated": "2019-12-11",
        "certification_date": "2019-12-11",
        "status": "A",
        "authorized_official_last_name": "KADDOURAH",
        "authorized_official_first_name": "IBRAHIM",
        "authorized_official_title_or_position": "OWNER/PIC",
        "authorized_official_telephone_number": "304-367-9122"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "WV",
            "license": "SP0552522",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2176926",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MED-MART PHARMACY FAIRMONT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Karalee McPherson, PHARMD
• Cheyann McQuain
• Veronica Marie McQuain
• Stephen McQueen, PA-C
• Darla Lee McRobie
• Medexpress Urgent Care, Inc. - West Virginia (MedExpress Urgent Care - Fairmont)
• Melissa a. Diamond, OD, PLLC (Eyecare One)
• Eugenio Aldea Menez, MD
• Brian R Menzies, DC
• Ramona Messenger

• Pharmacy in Fairmont, WV
• Providers in Fairmont, WV by specialty
• Pharmacy in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2019; 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.