Provider Demographics
NPI:1578796801
Name:HATCHER, BRAD WARREN (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRAD
Middle Name:WARREN
Last Name:HATCHER
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 1:110 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-2117
Mailing Address - Country:US
Mailing Address - Phone:304-389-0343
Mailing Address - Fax:
Practice Address - Street 1:6401 SISSONVILLE DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25312-9463
Practice Address - Country:US
Practice Address - Phone:304-984-9597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRPH0005372183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist