Provider Demographics
NPI:1376946509
Name:BECKLEY PHARMACY
Entity Type:Organization
Organization Name:BECKLEY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAWED
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERWANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-465-7200
Mailing Address - Street 1:435 MAIN ST W
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-3453
Mailing Address - Country:US
Mailing Address - Phone:681-207-7008
Mailing Address - Fax:681-207-7017
Practice Address - Street 1:105 ANWAR FATIMA LANE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801
Practice Address - Country:US
Practice Address - Phone:304-465-7200
Practice Address - Fax:304-465-0377
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BECKLEY PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-02
Last Update Date:2014-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV5010993333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6040073000Medicaid