Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 3336C0004X | Pharmacy | Compounding Pharmacy | 011010 | WEST VIRGINIA | No |
| 2 | 3336I0012X | Pharmacy | Institutional Pharmacy | 011010 | WEST VIRGINIA | No |
| 3 | 3336N0007X | Pharmacy | Nuclear Pharmacy | 011010 | WEST VIRGINIA | No |
| 4 | 3336H0001X | Pharmacy | Home Infusion Therapy Pharmacy | 011010 | WEST VIRGINIA | No |
| 5 | 3336S0011X | Pharmacy | Specialty Pharmacy | 011010 | WEST VIRGINIA | No |
| 6 | 3336L0003X | Pharmacy | Long Term Care Pharmacy | 011010 | WEST VIRGINIA | No |
| 7 | 3336C0002X | Pharmacy | Clinic Pharmacy | 011010 | WEST VIRGINIA | No |
| 8 | 333600000X | Pharmacy | | 011010 | WEST VIRGINIA | No |
| 9 | 3336C0003X | Pharmacy | Community/Retail Pharmacy | 011010 | WEST VIRGINIA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 0374850001 | MEDICARE NSC | | |
| 2 | 0143847000 | MEDICAID | WEST VIRGINIA | |