Provider Demographics
NPI:1821230376
Name:GWINN, LEE AARON (RPH)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:AARON
Last Name:GWINN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-9504
Mailing Address - Country:US
Mailing Address - Phone:304-647-1377
Mailing Address - Fax:304-647-9772
Practice Address - Street 1:840 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-9504
Practice Address - Country:US
Practice Address - Phone:304-647-1377
Practice Address - Fax:304-647-9772
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0006177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist