Mountaineer Medical Office Building Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

SP0552423 Issued in WV

Legal business name

MOUNTAINEER MEDICAL OFFICE BUILDING PHARMACY

Doing business as

Mountaineer Medical Pharmacy

Practice address

120 Medical Park Dr Ste 102
Bridgeport, WV 26330-9013

Phone

(304) 423-5200

Fax

(304) 848-6050

NPI assigned

Oct 27, 2011

Last updated

Jun 13, 2013By 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

Charles Bradley Franz

Title

Physician Member of LLC

Phone

(304) 624-7200

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Mountaineer Medical Pharmacy Doing business as

Locations

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.

• Melissa Minigh

  • Pharmacist
  • Bridgeport, WV
  • NPI 1144659574
  NPD (past)

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

{
    "created_epoch": "1319673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371081600000",
    "number": "1538445101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 MEDICAL PARK DR",
            "address_2": "SUITE 102",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263309012",
            "telephone_number": "304-423-5200",
            "fax_number": "304-848-6050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 MEDICAL PARK DR STE 102",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263309013",
            "telephone_number": "304-423-5200",
            "fax_number": "304-848-6050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAINEER MEDICAL OFFICE BUILDING PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-27",
        "last_updated": "2013-06-13",
        "status": "A",
        "authorized_official_last_name": "FRANZ",
        "authorized_official_first_name": "CHARLES BRADLEY",
        "authorized_official_title_or_position": "PHYSICIAN MEMBER OF LLC",
        "authorized_official_telephone_number": "304-624-7200"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WV",
            "license": "SP0552423",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2132729",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810022200",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountaineer Medical Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mountain State Medical Specialties, PLLC
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• Mountainear Audiology & Hearing Aid Center, LLC
• Mountaineer Family Practice PLLC
• Mountaineer Medical Pharmacy LLC
• Mountaineer Orthodontics, PLLC (Drs. Lacy, Weidman & Hazey III)
• Mountainstate Infectious Disease, PLLC (Mountainstate Infectious Disease)
• Khaldoun Mohamad Mozahem, MD
• Matthew Mullenax

• Community/Retail Pharmacy in Bridgeport, WV
• Providers in Bridgeport, 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 Jun 13, 2013; 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.