Provider Demographics
NPI:1497884183
Name:NESTOR, MANDY L (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:MANDY
Middle Name:L
Last Name:NESTOR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 538
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26571-9751
Mailing Address - Country:US
Mailing Address - Phone:304-986-2280
Mailing Address - Fax:304-986-2070
Practice Address - Street 1:109 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MANNINGTON
Practice Address - State:WV
Practice Address - Zip Code:26582-1126
Practice Address - Country:US
Practice Address - Phone:304-986-2280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0006776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist