Provider Demographics
NPI:1417616772
Name:RODEHEAVER, JOSH (CPHT)
Entity Type:Individual
Prefix:
First Name:JOSH
Middle Name:
Last Name:RODEHEAVER
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 SENIOR DR
Mailing Address - Street 2:
Mailing Address - City:TUNNELTON
Mailing Address - State:WV
Mailing Address - Zip Code:26444-9055
Mailing Address - Country:US
Mailing Address - Phone:304-594-6270
Mailing Address - Fax:
Practice Address - Street 1:2695 SENIOR DR
Practice Address - Street 2:
Practice Address - City:TUNNELTON
Practice Address - State:WV
Practice Address - Zip Code:26444-9055
Practice Address - Country:US
Practice Address - Phone:304-594-6270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT0010135183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician