NPIMap

Organization Active NPI

White Hall Pharmacy , LLC

  • Long Term Care Pharmacy
  • Fairmont, WV
National Provider Identifier
1508477332
Registry record updated Aug 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
WHITE HALL PHARMACY , LLC
Doing business as
White Hall Pharmacy, LLC
Practice address
177 Middletown Rd Ste 2
Fairmont, WV 26554-8254
Phone
(304) 368-9355
Fax
(304) 368-5422
NPI assigned
Aug 14, 2020
Last updated
Aug 17, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2020

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

Authorized official

Name
Terri W Vilain
Title
RPH/Owner
Phone
(130) 429-0910

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X
Compounding Pharmacy 3336C0004X
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

177 Middletown Rd Ste 2
Fairmont, WV 26554-8254

Mailing address

177 Middletown Rd Ste 2
Fairmont, WV 26554-8254
Phone (304) 368-9355

Other identifiers 1

IdentifierTypeStateIssuer
3810013966MedicaidWV

Other names 1

  • White Hall Pharmacy, LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
White Hall Pharmacy LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1597363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597622400000",
    "number": "1508477332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "177 MIDDLETOWN RD STE 2",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265548254",
            "telephone_number": "304-368-9355",
            "fax_number": "304-368-5422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "177 MIDDLETOWN RD STE 2",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265548254",
            "telephone_number": "304-368-9355",
            "fax_number": "304-368-5422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE HALL PHARMACY , LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-14",
        "last_updated": "2020-08-17",
        "certification_date": "2020-08-17",
        "status": "A",
        "authorized_official_last_name": "VILAIN",
        "authorized_official_first_name": "TERRI",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "RPH/OWNER",
        "authorized_official_telephone_number": "130-429-0910"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810013966",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "White Hall Pharmacy, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "White Hall Pharmacy, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairmont, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2020; 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.