Provider Demographics
NPI:1902406028
Name:MARESKE, ALEX CHARLES (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:CHARLES
Last Name:MARESKE
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 1:5014 DEMPSEY DR
Mailing Address - Street 2:
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313-2004
Mailing Address - Country:US
Mailing Address - Phone:304-687-3226
Mailing Address - Fax:
Practice Address - Street 1:77 NORMAN MORGAN BLVD
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3477
Practice Address - Country:US
Practice Address - Phone:304-752-7459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0010783183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty