Provider Demographics
NPI:1760578504
Name:HOFFMAN, CAROL A
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:A
Last Name:HOFFMAN
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 1:1937 NICKI STREET
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554
Mailing Address - Country:US
Mailing Address - Phone:304-363-7035
Mailing Address - Fax:304-278-7655
Practice Address - Street 1:426 MAIN STREET
Practice Address - Street 2:
Practice Address - City:RIVESVILLE
Practice Address - State:WV
Practice Address - Zip Code:26588
Practice Address - Country:US
Practice Address - Phone:304-278-7884
Practice Address - Fax:304-278-7655
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0002996183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist