Provider Demographics
NPI:1568781318
Name:METHENY, JOHN LYNDON (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LYNDON
Last Name:METHENY
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:PO BOX 621
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-0621
Mailing Address - Country:US
Mailing Address - Phone:304-269-8452
Mailing Address - Fax:
Practice Address - Street 1:456 CENTER AVE
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-2057
Practice Address - Country:US
Practice Address - Phone:304-269-4655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4756183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist