Provider Demographics
NPI:1639237498
Name:MONK, GANNETT PAUL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GANNETT
Middle Name:PAUL
Last Name:MONK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7035 HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25320-9721
Mailing Address - Country:US
Mailing Address - Phone:304-984-3237
Mailing Address - Fax:
Practice Address - Street 1:72 6TH AVE
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-2769
Practice Address - Country:US
Practice Address - Phone:304-727-2233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0005686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist