Provider Demographics
NPI:1124575907
Name:CMC PHARMACY, LLC
Entity Type:Organization
Organization Name:CMC PHARMACY, LLC
Other - Org Name:MED CENTER SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KARALIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-545-6040
Mailing Address - Street 1:3100 MACCORKLE AVE SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1223
Mailing Address - Country:US
Mailing Address - Phone:304-344-8021
Mailing Address - Fax:304-344-0655
Practice Address - Street 1:3100 MACCORKLE AVE SE
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1223
Practice Address - Country:US
Practice Address - Phone:304-344-8021
Practice Address - Fax:304-344-0655
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELWYN PHARMACY GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-08
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSP05524423336C0003X, 3336H0001X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810025009Medicaid
WV3810025009Medicaid
6814910001Medicare NSC