Provider Demographics
NPI:1902196108
Name:HASSAN, PAMELA K
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:K
Last Name:HASSAN
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 1:108 KYLE CT
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-4817
Mailing Address - Country:US
Mailing Address - Phone:304-324-7547
Mailing Address - Fax:
Practice Address - Street 1:101 MORRISON DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2322
Practice Address - Country:US
Practice Address - Phone:304-425-3024
Practice Address - Fax:304-425-3268
Is Sole Proprietor?:No
Enumeration Date:2011-04-09
Last Update Date:2011-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0005318183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist