Provider Demographics
NPI:1033708318
Name:CAMILLETTI, CASONDRA GAIL
Entity Type:Individual
Prefix:DR
First Name:CASONDRA
Middle Name:GAIL
Last Name:CAMILLETTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 VINE ST
Mailing Address - Street 2:
Mailing Address - City:FOLLANSBEE
Mailing Address - State:WV
Mailing Address - Zip Code:26037-1750
Mailing Address - Country:US
Mailing Address - Phone:304-479-3701
Mailing Address - Fax:
Practice Address - Street 1:126 12TH ST
Practice Address - Street 2:
Practice Address - City:WELLSBURG
Practice Address - State:WV
Practice Address - Zip Code:26070-1572
Practice Address - Country:US
Practice Address - Phone:304-737-0205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0012269183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist