Provider Demographics
NPI:1497824825
Name:CHAPMANVILLE PHARMACY INC
Entity Type:Organization
Organization Name:CHAPMANVILLE PHARMACY INC
Other - Org Name:CHAPMANVILLE PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIRGIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:304-752-7295
Mailing Address - Street 1:PO BOX 4403
Mailing Address - Street 2:
Mailing Address - City:CHAPMANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25508-4403
Mailing Address - Country:US
Mailing Address - Phone:304-855-9502
Mailing Address - Fax:
Practice Address - Street 1:289 CRAWLEY CREEK RD
Practice Address - Street 2:
Practice Address - City:CHAPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508
Practice Address - Country:US
Practice Address - Phone:304-855-9502
Practice Address - Fax:304-855-9505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WVSP05523193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810004291Medicaid
2111568OtherPK