Provider Demographics
NPI:1750726444
Name:WV RURAL HEALTHCARE PARTNERSHIP
Entity type:Organization
Organization Name:WV RURAL HEALTHCARE PARTNERSHIP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:304-205-7534
Mailing Address - Street 1:4602 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1848
Mailing Address - Country:US
Mailing Address - Phone:304-205-7534
Mailing Address - Fax:304-205-7548
Practice Address - Street 1:4602 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1848
Practice Address - Country:US
Practice Address - Phone:304-205-7534
Practice Address - Fax:304-205-7548
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CABIN CREEK HEALTH SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-08
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSP05524773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy