Provider Demographics
NPI:1346725116
Name:MCGREW, TODD ALLEN
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:ALLEN
Last Name:MCGREW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 21ST ST
Mailing Address - Street 2:
Mailing Address - City:NITRO
Mailing Address - State:WV
Mailing Address - Zip Code:25143-1739
Mailing Address - Country:US
Mailing Address - Phone:304-755-0128
Mailing Address - Fax:304-204-2223
Practice Address - Street 1:101 21ST ST
Practice Address - Street 2:
Practice Address - City:NITRO
Practice Address - State:WV
Practice Address - Zip Code:25143-1739
Practice Address - Country:US
Practice Address - Phone:304-755-0128
Practice Address - Fax:304-204-2223
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV05509113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy