Provider Demographics
NPI:1518269042
Name:GURGANUS, MARCIA (RPH)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:GURGANUS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 STAFFORD DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2465
Mailing Address - Country:US
Mailing Address - Phone:304-487-1155
Mailing Address - Fax:
Practice Address - Street 1:1213 STAFFORD DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2465
Practice Address - Country:US
Practice Address - Phone:304-487-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-05
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV5088183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist