Provider Demographics
NPI:1275134942
Name:MEADOWS, DAVID WALTHALL (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WALTHALL
Last Name:MEADOWS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9318
Mailing Address - Country:US
Mailing Address - Phone:304-573-9987
Mailing Address - Fax:
Practice Address - Street 1:3333 US ROUTE 60
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2848
Practice Address - Country:US
Practice Address - Phone:304-525-4266
Practice Address - Fax:304-525-4379
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-08
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0003063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist