Provider Demographics
NPI:1013214139
Name:NESSELROADE, RODNEY P (RPH)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:P
Last Name:NESSELROADE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-2021
Mailing Address - Country:US
Mailing Address - Phone:304-269-7963
Mailing Address - Fax:304-269-2193
Practice Address - Street 1:218 E 3RD ST
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-2021
Practice Address - Country:US
Practice Address - Phone:304-269-7963
Practice Address - Fax:304-269-2193
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0005166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist