Provider Demographics
NPI:1861824906
Name:HUSTED, BRIANNA M (PHARM D)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:M
Last Name:HUSTED
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 CHESTER DR
Mailing Address - Street 2:APT #204
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-5608
Mailing Address - Country:US
Mailing Address - Phone:717-330-0309
Mailing Address - Fax:
Practice Address - Street 1:3801 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1527
Practice Address - Country:US
Practice Address - Phone:304-925-2168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0008158183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist