Provider Demographics
NPI:1699818377
Name:BECKLEY PHARMACY INC.
Entity type:Organization
Organization Name:BECKLEY PHARMACY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAWED
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERWANI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:304-465-7200
Mailing Address - Street 1:455 STANAFORD RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3145
Mailing Address - Country:US
Mailing Address - Phone:304-252-1200
Mailing Address - Fax:304-256-8494
Practice Address - Street 1:455 STANAFORD RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3145
Practice Address - Country:US
Practice Address - Phone:304-252-1200
Practice Address - Fax:304-256-8494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV50120363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6040073000Medicaid
WV3972190002Medicare NSC