Provider Demographics
NPI:1780013698
Name:MOOREHEAD, FREDERICK BRICE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:BRICE
Last Name:MOOREHEAD
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 1:2800 MEADOWBROOK MALL
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9795
Mailing Address - Country:US
Mailing Address - Phone:304-842-7779
Mailing Address - Fax:
Practice Address - Street 1:2800 MEADOWBROOK MALL
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9795
Practice Address - Country:US
Practice Address - Phone:304-842-7779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0006581183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist