Provider Demographics
NPI:1033101597
Name:THERA-PHARM SOLUTIONS LLC
Entity Type:Organization
Organization Name:THERA-PHARM SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENVER
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEHAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D CGP
Authorized Official - Phone:304-263-2254
Mailing Address - Street 1:217 S GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-1915
Mailing Address - Country:US
Mailing Address - Phone:304-263-2254
Mailing Address - Fax:304-263-5005
Practice Address - Street 1:217 S GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-1915
Practice Address - Country:US
Practice Address - Phone:304-263-2254
Practice Address - Fax:304-263-5005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV003215183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty