Provider Demographics
NPI:1609175520
Name:MENEGO, IRENE B (RPH)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:B
Last Name:MENEGO
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 1:904 LINCOLN STREET
Mailing Address - Street 2:
Mailing Address - City:MULLENS
Mailing Address - State:WV
Mailing Address - Zip Code:25882
Mailing Address - Country:US
Mailing Address - Phone:304-294-6445
Mailing Address - Fax:
Practice Address - Street 1:418 APPLICIAN HIGHWAY
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:WV
Practice Address - Zip Code:24874
Practice Address - Country:US
Practice Address - Phone:304-732-8886
Practice Address - Fax:304-732-9550
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4176183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4176OtherWEST VIRGINIA BOARD OF PHARMACY