Provider Demographics
NPI:1013373919
Name:ETTER, RITA (RPH)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:ETTER
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 1:77 NORMAN MORGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-3477
Mailing Address - Country:US
Mailing Address - Phone:304-752-7459
Mailing Address - Fax:
Practice Address - Street 1:77 NORMAN MORGAN BLVD
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3477
Practice Address - Country:US
Practice Address - Phone:304-752-7459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-07
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012314183500000X
WVRP0006343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist