Provider Demographics
NPI:1679852297
Name:SWEENEY, VINCENT
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:SWEENEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5870 WEBSTER RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-9105
Mailing Address - Country:US
Mailing Address - Phone:304-872-4394
Mailing Address - Fax:304-872-5783
Practice Address - Street 1:5870 WEBSTER RD
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-9105
Practice Address - Country:US
Practice Address - Phone:304-872-4394
Practice Address - Fax:304-872-5783
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0007695183500000X
NC22022183500000X
VA0202210856183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist