Provider Demographics
NPI:1568863587
Name:FERREBEE, WALTER JAY (RPH)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:JAY
Last Name:FERREBEE
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 1:800 GRAND CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-2150
Mailing Address - Country:US
Mailing Address - Phone:304-295-4506
Mailing Address - Fax:304-295-9436
Practice Address - Street 1:800 GRAND CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-2150
Practice Address - Country:US
Practice Address - Phone:304-295-4506
Practice Address - Fax:304-295-9436
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0004743183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist