Provider Demographics
NPI:1609157759
Name:FAST & FRIENDLY PHARMACY RC LLC
Entity Type:Organization
Organization Name:FAST & FRIENDLY PHARMACY RC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:METHENY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:304-269-3737
Mailing Address - Street 1:PO BOX 621
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-0621
Mailing Address - Country:US
Mailing Address - Phone:304-269-3737
Mailing Address - Fax:304-269-3770
Practice Address - Street 1:4 GARTON PLZ
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-2129
Practice Address - Country:US
Practice Address - Phone:304-269-3737
Practice Address - Fax:304-269-3770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-02
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSP0552418333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7389910001Medicare NSC