Provider Demographics
NPI:1003348889
Name:BERNABEI, SUE (RPH)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:BERNABEI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4009 PALISADES DR
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-4328
Mailing Address - Country:US
Mailing Address - Phone:304-670-6404
Mailing Address - Fax:304-723-1131
Practice Address - Street 1:651 COLLIERS WAY
Practice Address - Street 2:SUITE 204
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5053
Practice Address - Country:US
Practice Address - Phone:304-723-6331
Practice Address - Fax:304-723-1131
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4814183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist