Provider Demographics
NPI:1114375771
Name:PAINTER, MARK II (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:PAINTER
Suffix:II
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 CAMDEN RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704-2708
Mailing Address - Country:US
Mailing Address - Phone:304-429-5544
Mailing Address - Fax:
Practice Address - Street 1:425 CAMDEN RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704-2708
Practice Address - Country:US
Practice Address - Phone:304-429-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0008740183500000X
OH03234213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist