Charlie's Pharmacy of Mullens, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

552361 Issued in WV

Legal business name

CHARLIE'S PHARMACY OF MULLENS, LLC

Practice address

224 Howard Ave
Mullens, WV 25882-1421

Phone

(304) 294-5447

Fax

(304) 294-5314

NPI assigned

Oct 23, 2007

Organization subpart

No

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

Authorized official

Name

Kevin Wilson, PHARM DNPI 1073258109

Title

Manager

Phone

(304) 294-5447

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WV2 enrollments

Enrollment records 2

Tax ID family

Charlie's Pharmacy of Mullens LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Charlie's Pharmacy of Mullens, LLC

  • Long Term Care Pharmacy
  • Mullens, WV
  • NPI 1396623898
  NPD tax ID

Locations

Practitioners 1

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

• Kevin G Wilson, PHARMD

  • Pharmacist
  • Mullens, WV
  • NPI 1073258109
  NPD Authorized official

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

{
    "created_epoch": "1193097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666310400000",
    "number": "1942499223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 788",
            "city": "MULLENS",
            "state": "WV",
            "postal_code": "258820788",
            "telephone_number": "304-294-5447",
            "fax_number": "304-294-5314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 HOWARD AVE",
            "city": "MULLENS",
            "state": "WV",
            "postal_code": "258821421",
            "telephone_number": "304-294-5447",
            "fax_number": "304-294-5314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLIE'S PHARMACY OF MULLENS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-23",
        "last_updated": "2022-10-21",
        "certification_date": "2022-10-21",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "304-294-5447",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WV",
            "license": "552361",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810010896",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pamela Carter
• Tonia Carver
• Carol Chaffins
• Charles E. Porterfield
• Charlie's Pharmacy of Mullens, LLC
• Charlies Pharmacy Inc (Charlies Pharmacy)
• Cynthia Christian
• Lisa Christian
• City of Mullens
• Brenda Clagg

• Community/Retail Pharmacy in Mullens, WV
• Providers in Mullens, WV by specialty
• Community/Retail Pharmacy in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2022; 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.