Provider Demographics
NPI:1407267172
Name:BECKLEY PHARMACY
Entity Type:Organization
Organization Name:BECKLEY PHARMACY
Other - Org Name:BECKLEY PHARMACY, DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAWED
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERWANI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:304-465-7200
Mailing Address - Street 1:455 STANAFORD RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3145
Mailing Address - Country:US
Mailing Address - Phone:304-252-1200
Mailing Address - Fax:304-256-8498
Practice Address - Street 1:455 STANAFORD RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3145
Practice Address - Country:US
Practice Address - Phone:304-252-1200
Practice Address - Fax:304-256-8498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6040073000Medicaid