1386341998 NPI number — COX FAMILY PHARMACY INC

Table of content: MYSTIQUE HARGROVE MS, CFSD, CBS, CBE (NPI 1417674656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386341998 NPI number — COX FAMILY PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COX FAMILY PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386341998
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2012 GARFIELD AVE STE 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKERSBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26101-2541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-483-5662
Provider Business Mailing Address Fax Number:
304-375-8133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
426 HIGHLAND AVE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26187-1249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-375-8130
Provider Business Practice Location Address Fax Number:
304-375-8133
Provider Enumeration Date:
02/14/2023

Additional Information

Authorized Official

Authorized Official Last Name:
COX
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
304-375-8130

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MP0552574 . This is a "WV BOARD OF PHARMACY" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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