NPIMap

Organization Active NPI

Jerry Skeenes

Doing business as Alum Creek Pharmacy at Sand Plant

  • Community/Retail Pharmacy
  • South Charleston, WV
National Provider Identifier
1811090954
Registry record updated Mar 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
SP0552446 Issued in WV
Legal business name
JERRY SKEENES
Doing business as
Alum Creek Pharmacy at Sand Plant
Practice address
1563 Sand Plant Rd
South Charleston, WV 25309-6120
Phone
(304) 756-2181
Fax
(304) 756-2796
NPI assigned
Sep 6, 2006
Last updated
Mar 25, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2013

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

Authorized official

Name
Jerry SkeenesNPI 1568981058
Title
Owner
Phone
(304) 756-2181

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X SP0552446 WV Primary

Addresses

Primary practice location

1563 Sand Plant Rd
South Charleston, WV 25309-6120

Mailing address

PO Box 37
Alum Creek, WV 25003-0037
Phone (304) 756-2181

Other identifiers 2

IdentifierTypeStateIssuer
5001261OtherNCPDP PROVIDER IDENTIFICATION NUMBER
139035000MedicaidWV

Other names 1

  • ALUM CREEK PHARMACY AT SAND PLANT 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, 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": "1157500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364169600000",
    "number": "1811090954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 37",
            "city": "ALUM CREEK",
            "state": "WV",
            "postal_code": "250030037",
            "telephone_number": "304-756-2181",
            "fax_number": "304-756-2796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1563 SAND PLANT RD",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253096120",
            "telephone_number": "304-756-2181",
            "fax_number": "304-756-2796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY SKEENES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-06",
        "last_updated": "2013-03-25",
        "status": "A",
        "authorized_official_last_name": "SKEENES",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-756-2181"
    },
    "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": "SP0552446",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5001261",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "139035000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ALUM CREEK PHARMACY AT SAND PLANT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Charleston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 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.