Provider Demographics
NPI:1477888311
Name:GIANETTINO, KENNETH HAROLD (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:HAROLD
Last Name:GIANETTINO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 N 20TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-1570
Mailing Address - Country:US
Mailing Address - Phone:304-844-6276
Mailing Address - Fax:
Practice Address - Street 1:111 MAIN ST
Practice Address - Street 2:
Practice Address - City:ANSTED
Practice Address - State:WV
Practice Address - Zip Code:25812
Practice Address - Country:US
Practice Address - Phone:304-658-4426
Practice Address - Fax:304-658-9129
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00025991835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist