Provider Demographics
NPI:1932573425
Name:WV CHS PHARMACY SERVICES, LLC
Entity type:Organization
Organization Name:WV CHS PHARMACY SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACY OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:G
Authorized Official - Last Name:MAREK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:513-530-1808
Mailing Address - Street 1:10123 ALLIANCE RD
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4887
Mailing Address - Country:US
Mailing Address - Phone:513-489-7100
Mailing Address - Fax:
Practice Address - Street 1:15063 MACCORKLE AVE., SE
Practice Address - Street 2:
Practice Address - City:CABIN CREEK
Practice Address - State:WV
Practice Address - Zip Code:25035-8047
Practice Address - Country:US
Practice Address - Phone:304-595-4900
Practice Address - Fax:304-595-4652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 3336L0003X
WVSP0552501333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1932573425Medicaid
2157687OtherPK