MED-MART PHARMACY LLC (NPI# 1649772351) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649772351 |
| Entity Type | Organization |
| Organization Name | MED-MART PHARMACY LLC |
| Other Organization Name | MED-MART PHARMACY LLC |
| Practice Address |
100 Main Street Farmington WV 26571 |
| Mailing Address |
2524 Sun Trl Morgantown WV 26505-1131 |
| Practice Telephone | 3046906165 |
| Practice Fax Number | 3046906165 |
| Mailing Telephone | 3046906165 |
| Enumeration Date | 2018-03-08 |
| Last Update Date | 2018-03-08 |
| Authorized Official Name | IBRAHIM KADDOURAH (OWNER/PIC) |
| Authorized Official Telephone | 3046906165 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
SP0552520 | WV | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2176332 | 01 |
| Other Name | Type Code |
|---|---|
| MED-MART PHARMACY FARMINGTON | Doing Business As Name - Organization |
| MED-MART PHARMACY LLC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740501543 | Med-mart Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 87 C V B Dr, London, KY 40741-1096 | 2010-06-15 |
| 1386131050 | Med-mart Pharmacy LLC | Pharmacy | 181 Middletown Cir, Fairmont, WV 26554-2015 | 2018-04-18 |
| Street Address |
100 MAIN STREET |
| City | FARMINGTON |
| State | WV |
| Zip Code | 26571 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861003667 | Norma Lucille Devericks | Technician | 173 Horseshoe Rd, Farmington, WV 26571 | 2020-08-14 |
| 1396946570 | John Manchin II & John Manchin IIi | Chiropractor | 100 Main St, Farmington, WV 26571 | 2007-05-29 |
| 1326122060 | John Manchin IIi | Pharmacy | 1021 Main St, Farmington, WV 26571 | 2006-10-25 |
| 1134231640 | John Manchin II | Family Medicine | 100 Main St, Farmington, WV 26571 | 2006-08-31 |
| 1124299813 | Angela M Hager | Physician Assistant | 100 Main St, Farmington, WV 26571-0029 | 2008-03-20 |
| 1578670139 | Stephen Girard Sinclair | Dentist | 1021 Main St, Manchin Clinic 3rd Flr, Farmington, WV 26571-0510 | 2006-08-23 |
| 1093326191 | Richard William Ours | Technician | 9 Top St, Farmington, WV 26571-7903 | 2020-08-12 |
| 1093316333 | Barbara J Dadisman | Technician | 364 Parrish Run Rd, Farmington, WV 26571-8097 | 2020-11-03 |
| 1336740018 | Helen K Morrison | Technician | 364 Parrish Run Rd, Farmington, WV 26571-8097 | 2020-11-08 |
| 1417022773 | Matthew Glen Berardi | Optometrist | 3208 Husky Hwy, Farmington, WV 26571-8122 | 2006-11-22 |
| Find all providers in zip 26571 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033749395 | Cod Management LLC | Pharmacy | 23133 Orchard Lake Rd Ste 101, Farmington, MI 48336-3278 | 2020-01-24 |
| 1629551759 | Uconn Health Pharmacy Services Inc | Pharmacy | 270 Farmington Ave Ste 108, Farmington, CT 06032-1965 | 2018-09-14 |
| 1053801340 | Mears Pharmacy | Pharmacy | 1050 Shepard Ln Ste 1, Farmington, UT 84025-2716 | 2018-05-13 |
| 1669985396 | Pharmingtonrx, LLC | Pharmacy | 806 Valley Creek Dr, Farmington, MO 63640-1969 | 2017-11-16 |
| 1811313216 | Jill's Genuine Care Pharmacy, LLC | Pharmacy | 23354 Farmington Rd, Farmington, MI 48336-3102 | 2014-03-10 |
| 1326463936 | Four Corners Compounding | Pharmacy | 2300 E 30th St Ste B-101, Farmington, NM 87401-8991 | 2014-02-19 |
| 1205000601 | Dalco, Inc. | Pharmacy | 120 E Karsch Blvd, Farmington, MO 63640-1238 | 2008-04-16 |
| 1164585469 | Farmington Drug | Pharmacy | 507 E 20th St, Farmington, NM 87401-2105 | 2006-12-18 |
| 1154433084 | Woodward Detroit Cvs, L.L.C. | Pharmacy | 23391 Farmington Rd, Farmington, MI 48336-3103 | 2006-08-31 |
| 1710993118 | Walgreen Co | Pharmacy | 4221 E Main St, Farmington, NM 87402-8637 | 2006-07-31 |
| Find all providers in FARMINGTON | ||||
| City | FARMINGTON |
| Zip Code | 26571 |
Please comment or provide details below to improve the information on MED-MART PHARMACY LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.