Provider Demographics
NPI:1558583682
Name:LAFFERTY, AMY DENISE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:DENISE
Last Name:LAFFERTY
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 1:3805 MACCORKLE AVE, SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304
Mailing Address - Country:US
Mailing Address - Phone:304-926-6433
Mailing Address - Fax:304-926-6591
Practice Address - Street 1:3805 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304
Practice Address - Country:US
Practice Address - Phone:304-926-6433
Practice Address - Fax:304-926-6591
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0006487183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist