Provider Demographics
NPI:1114219474
Name:CHIPRX LLC
Entity Type:Organization
Organization Name:CHIPRX LLC
Other - Org Name:CITY CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-824-3784
Mailing Address - Street 1:PO BOX 671
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:WV
Mailing Address - Zip Code:25523-0671
Mailing Address - Country:US
Mailing Address - Phone:304-824-3787
Mailing Address - Fax:
Practice Address - Street 1:8119 COURT AVE
Practice Address - Street 2:
Practice Address - City:HAMLIN
Practice Address - State:WV
Practice Address - Zip Code:25523-1402
Practice Address - Country:US
Practice Address - Phone:304-824-3784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-05
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WVSP05524273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5055579OtherNCPDP PROVIDER IDENTIFICATION NUMBER
WV6677890001Medicare NSC