NPIMap

Organization Active NPI

Kingwood Pharmacy LLC

  • Community/Retail Pharmacy
  • Kingwood, WV
National Provider Identifier
1750379632
Registry record updated Dec 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
SP0550847 Issued in WV
Legal business name
KINGWOOD PHARMACY LLC
Doing business as
Kingwood Pharmacy LLC
Practice address
220 W Main St
Kingwood, WV 26537-1419
Phone
(304) 329-3600
Fax
(304) 329-3356
NPI assigned
Oct 13, 2005
Last updated
Dec 3, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2014

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

Authorized official

Name
Jennifer ReeseNPI 1912147505
Title
Owner/Manager
Phone
(304) 329-3600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X SP0550847 WV Primary

Addresses

Primary practice location

220 W Main St
Kingwood, WV 26537-1419

Mailing address

220 W Main St
Kingwood, WV 26537-1419
Phone (304) 329-3600

Other identifiers 2

IdentifierTypeStateIssuer
0143462000MedicaidWV
2143678OtherPK

Other names 1

  • Kingwood Pharmacy LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140312000774 WV DME Supplier - Pharmacy 1254561350 Practice locations: Kingwood, WV

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Kingwood Pharmacy LLC220 W Main St, Kingwood, WV 26537-1419(304) 329-3600 Nebulizer Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order) Does not accept assignmentParticipating since Feb 18, 2014

National Provider Directory

National Provider Directory

Locations

220 W Main St
Kingwood, WV 26537
Phone (304) 329-3600

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1129161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417564800000",
    "number": "1750379632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 W MAIN ST",
            "city": "KINGWOOD",
            "state": "WV",
            "postal_code": "265371419",
            "telephone_number": "304-329-3600",
            "fax_number": "304-329-3356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 W MAIN ST",
            "city": "KINGWOOD",
            "state": "WV",
            "postal_code": "265371419",
            "telephone_number": "304-329-3600",
            "fax_number": "304-329-3356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGWOOD PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-13",
        "last_updated": "2014-12-03",
        "status": "A",
        "authorized_official_last_name": "REESE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "304-329-3600"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WV",
            "license": "SP0550847",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0143462000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2143678",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kingwood Pharmacy LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kingwood, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.