NPIMap

Organization Active NPI

Pharmacole Inc

Doing business as Moundsville Pharmacy

  • Community/Retail Pharmacy
  • Moundsville, WV
National Provider Identifier
1790867570
Registry record updated Mar 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
NRP.022335850-03 Issued in OH
Legal business name
PHARMACOLE INC
Doing business as
Moundsville Pharmacy
Practice address
118 Lafayette Ave
Moundsville, WV 26041-1029
Phone
(304) 845-0390
Fax
(304) 845-0391
NPI assigned
Oct 20, 2006
Last updated
Mar 15, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2017

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

Authorized official

Name
Jason Turner, PHARMDNPI 1083726475
Title
Owner, Pic
Phone
(304) 845-0390

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X NRP.022335850-03 OH Primary
Compounding Pharmacy 3336C0004X SP0550787 WV

Addresses

Primary practice location

118 Lafayette Ave
Moundsville, WV 26041-1029

Mailing address

118 Lafayette Ave
Moundsville, WV 26041-1029
Phone (304) 845-0390

Other identifiers 2

IdentifierTypeStateIssuer
0143297000MedicaidWV
2109812OtherPK

Other names 1

  • MOUNDSVILLE PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20061220000566 WV Part B Supplier - Mass Immunization (Roster Biller Only) 6204835275 Practice locations: Moundsville, WV
O20100930013798 WV DME Supplier - Pharmacy 6204835275 Practice locations: Moundsville, WV

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Pharmacole Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the 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, 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": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489536000000",
    "number": "1790867570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 LAFAYETTE AVE",
            "city": "MOUNDSVILLE",
            "state": "WV",
            "postal_code": "260411029",
            "telephone_number": "304-845-0390",
            "fax_number": "304-845-0391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 LAFAYETTE AVE",
            "city": "MOUNDSVILLE",
            "state": "WV",
            "postal_code": "260411029",
            "telephone_number": "304-845-0390",
            "fax_number": "304-845-0391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHARMACOLE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2017-03-15",
        "status": "A",
        "authorized_official_last_name": "TURNER",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "OWNER, PIC",
        "authorized_official_telephone_number": "304-845-0390",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OH",
            "license": "NRP.022335850-03",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "WV",
            "license": "SP0550787",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0143297000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2109812",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MOUNDSVILLE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moundsville, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.