Provider Demographics
NPI:1265592679
Name:CABIN CREEK HEALTH CENTER PHARMACY
Entity type:Organization
Organization Name:CABIN CREEK HEALTH CENTER PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LEAD PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:681-205-8730
Mailing Address - Street 1:104 ALEX LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2952
Mailing Address - Country:US
Mailing Address - Phone:304-734-2040
Mailing Address - Fax:304-734-2047
Practice Address - Street 1:STATE ROUTE 79 CABIN CREEK ROAD
Practice Address - Street 2:
Practice Address - City:DAWES
Practice Address - State:WV
Practice Address - Zip Code:25054-0070
Practice Address - Country:US
Practice Address - Phone:304-595-5065
Practice Address - Fax:304-595-2936
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CABIN CREEK HEALTH CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-08
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0140322000Medicaid
WV0140322000Medicaid