NPIMap

Organization Active NPI

John Manchin III

  • Clinic Pharmacy
  • Fairmont, WV
National Provider Identifier
1689849804
Registry record updated Apr 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
SP0552377 Issued in WV
Legal business name
JOHN MANCHIN III
Doing business as
MANCHIN FAMILY PHARMACY
Practice address
181 Middletown Cir
Fairmont, WV 26554-2015
Phone
(304) 367-9122
Fax
(304) 367-9125
NPI assigned
Apr 29, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2017

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

Authorized official

Name
John Manchin III, B.S.
Title
Owner
Phone
(304) 367-9122

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X SP0552377 WV Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

181 Middletown Cir
Fairmont, WV 26554-2015

Mailing address

181 Middletown Cir
Fairmont, WV 26554-2015
Phone (304) 367-9122

Other identifiers 2

IdentifierTypeStateIssuer
2111736OtherPK
3810011348MedicaidWV

Other names 1

  • MANCHIN FAMILY PHARMACY Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1209427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493078400000",
    "number": "1689849804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "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": "JOHN MANCHIN III",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-29",
        "last_updated": "2017-04-25",
        "status": "A",
        "authorized_official_last_name": "MANCHIN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-367-9122",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "B.S."
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "WV",
            "license": "SP0552377",
            "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": "2111736",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810011348",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MANCHIN FAMILY PHARMACY",
            "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 Apr 25, 2017; 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.