Provider Demographics
NPI:1174838296
Name:STITZINGER, KERRY ANN (RPH)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:ANN
Last Name:STITZINGER
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 1:406 WASHINGTON ST W
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-2131
Mailing Address - Country:US
Mailing Address - Phone:304-343-8804
Mailing Address - Fax:304-343-1799
Practice Address - Street 1:406 WASHINGTON ST W
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-2131
Practice Address - Country:US
Practice Address - Phone:304-343-8804
Practice Address - Fax:304-343-1799
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV5645183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist