Provider Demographics
NPI:1558665810
Name:ALT, PAMELA (RPH)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:ALT
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 1:196 BLUE LICK RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:25213-9726
Mailing Address - Country:US
Mailing Address - Phone:304-755-1390
Mailing Address - Fax:
Practice Address - Street 1:196 BLUE LICK RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:WV
Practice Address - Zip Code:25213-9726
Practice Address - Country:US
Practice Address - Phone:304-755-1390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP00003483183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist