Provider Demographics
NPI:1639163538
Name:WEST VIRGINIA UNIVERSITY HOSPITALS INC
Entity Type:Organization
Organization Name:WEST VIRGINIA UNIVERSITY HOSPITALS INC
Other - Org Name:MEDICAL CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, MED CTR PHCY
Authorized Official - Prefix:
Authorized Official - First Name:JOEDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZAGA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:304-598-4848
Mailing Address - Street 1:PO BOX 8100
Mailing Address - Street 2:MEDICAL CENTER DRIVE
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-8100
Mailing Address - Country:US
Mailing Address - Phone:304-598-4848
Mailing Address - Fax:304-598-6382
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-1200
Practice Address - Country:US
Practice Address - Phone:304-598-4848
Practice Address - Fax:304-598-6382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSP0550189333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2109860OtherPK
OH0054045Medicaid
WV0144432000Medicaid
PA1007552330009Medicaid
MD332306400Medicaid
3578200001Medicare NSC