Provider Demographics
NPI:1609324284
Name:APEX PHARMACY LLC
Entity Type:Organization
Organization Name:APEX PHARMACY LLC
Other - Org Name:APEX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:KIBLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:681-207-7334
Mailing Address - Street 1:165 RAGLAND RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-9763
Mailing Address - Country:US
Mailing Address - Phone:681-207-7334
Mailing Address - Fax:681-207-7338
Practice Address - Street 1:165 RAGLAND RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-9763
Practice Address - Country:US
Practice Address - Phone:681-207-7334
Practice Address - Fax:681-207-7338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-13
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVOP0552223333600000X
3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2164262OtherPK