Provider Demographics
NPI:1497797724
Name:MICHELS PHARMACY
Entity Type:Organization
Organization Name:MICHELS PHARMACY
Other - Org Name:MICHELS PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-873-1010
Mailing Address - Street 1:224 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:WV
Mailing Address - Zip Code:26456-2094
Mailing Address - Country:US
Mailing Address - Phone:304-873-1010
Mailing Address - Fax:304-973-2446
Practice Address - Street 1:224 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:WV
Practice Address - Zip Code:26456-2094
Practice Address - Country:US
Practice Address - Phone:304-873-1010
Practice Address - Fax:304-973-2446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WVSP05508253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2109497OtherPK
WV013955000Medicaid
0140767000Medicare NSC