Provider Demographics
NPI:1598054884
Name:DOBBERKE, SCOTT CRAIG (RPH)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:CRAIG
Last Name:DOBBERKE
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 1:781 VIRGINIA AVE
Mailing Address - Street 2:RITE-AID PHARMACY
Mailing Address - City:WELCH
Mailing Address - State:WV
Mailing Address - Zip Code:24801-2341
Mailing Address - Country:US
Mailing Address - Phone:304-436-6360
Mailing Address - Fax:304-436-4658
Practice Address - Street 1:781 VIRGINIA AVE
Practice Address - Street 2:RITE-AID PHARMACY
Practice Address - City:WELCH
Practice Address - State:WV
Practice Address - Zip Code:24801-2341
Practice Address - Country:US
Practice Address - Phone:304-436-6360
Practice Address - Fax:304-436-4658
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0005337183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist