Provider Demographics
NPI:1396623898
Name:CHARLIE'S PHARMACY OF MULLENS, LLC
Entity type:Organization
Organization Name:CHARLIE'S PHARMACY OF MULLENS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER LLC
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:304-294-5447
Mailing Address - Street 1:PO BOX 788
Mailing Address - Street 2:
Mailing Address - City:MULLENS
Mailing Address - State:WV
Mailing Address - Zip Code:25882-0788
Mailing Address - Country:US
Mailing Address - Phone:304-294-5447
Mailing Address - Fax:304-294-5314
Practice Address - Street 1:224 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:MULLENS
Practice Address - State:WV
Practice Address - Zip Code:25882-1421
Practice Address - Country:US
Practice Address - Phone:304-294-5447
Practice Address - Fax:304-294-5314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy