Coal River Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

SP0552365 Issued in WV

Legal business name

COAL RIVER PHARMACY LLC

Practice address

21189 Coal River Rd
Comfort, WV 25049

Phone

(304) 837-3777

Fax

(304) 837-3776

NPI assigned

Jan 2, 2008

Organization subpart

No

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

Authorized official

Name

Stephanie Massey

Title

Owner

Phone

(304) 837-3777

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• FAMILY LIFE PHARMACY Doing business as

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

{
    "created_epoch": "1199232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618272000000",
    "number": "1891970414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190",
            "city": "SETH",
            "state": "WV",
            "postal_code": "251810190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21189 COAL RIVER RD",
            "city": "COMFORT",
            "state": "WV",
            "postal_code": "25049",
            "telephone_number": "304-837-3777",
            "fax_number": "304-837-3776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COAL RIVER PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-02",
        "last_updated": "2021-04-13",
        "certification_date": "2021-04-13",
        "status": "A",
        "authorized_official_last_name": "MASSEY",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-837-3777"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WV",
            "license": "SP0552365",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810011065",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2111653",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAMILY LIFE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FAMILY LIFE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Addiction Wellness Center WV LLC
• Nancy Armentrout
• Boone Memorial Hospital, Inc
• Boone Memorial Hospital, Inc
• Hygeia Facilities Foundation, Inc.
• Lincoln County Primary Care Center Inc
• Lotus Recovery Center of Comfort LLC
• Michael Lovejoy
• Carrie Sharps

• All providers in Comfort, WV
• Community/Retail Pharmacy in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2021; 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.