Provider Demographics
NPI:1689430464
Name:FRIEND, JUNIOR
Entity Type:Individual
Prefix:
First Name:JUNIOR
Middle Name:
Last Name:FRIEND
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 1:145 LITTLE BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:ROWLESBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26425-9233
Mailing Address - Country:US
Mailing Address - Phone:304-698-5971
Mailing Address - Fax:
Practice Address - Street 1:145 LITTLE BUFFALO RD
Practice Address - Street 2:
Practice Address - City:ROWLESBURG
Practice Address - State:WV
Practice Address - Zip Code:26425-9233
Practice Address - Country:US
Practice Address - Phone:304-698-5971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker