Provider Demographics
NPI:1083780191
Name:RPHV LLC
Entity Type:Organization
Organization Name:RPHV LLC
Other - Org Name:RPHV LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:G
Authorized Official - Phone:304-754-5800
Mailing Address - Street 1:71 COWARDLY LION DR
Mailing Address - Street 2:
Mailing Address - City:HEDGESVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25427-6785
Mailing Address - Country:US
Mailing Address - Phone:304-754-5800
Mailing Address - Fax:304-754-3400
Practice Address - Street 1:71 COWARDLY LION DR
Practice Address - Street 2:
Practice Address - City:HEDGESVILLE
Practice Address - State:WV
Practice Address - Zip Code:25427-6785
Practice Address - Country:US
Practice Address - Phone:304-754-5800
Practice Address - Fax:304-754-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WVMP05523143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0141848001Medicaid
2111414OtherPK