Provider Demographics
NPI:1619266517
Name:ALBAUGH, JENNIFER SUE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUE
Last Name:ALBAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4077 ROBERT C. BYRD DRIVE
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2203
Mailing Address - Country:US
Mailing Address - Phone:304-252-7313
Mailing Address - Fax:
Practice Address - Street 1:4077 ROBERT C. BYRD DRIVE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2203
Practice Address - Country:US
Practice Address - Phone:304-252-7313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV5768183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist