Provider Demographics
NPI:1942934948
Name:LANCASTER-KINNEY, MARYLYN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARYLYN
Middle Name:
Last Name:LANCASTER-KINNEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 RUCKERT RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-2754
Mailing Address - Country:US
Mailing Address - Phone:304-376-4224
Mailing Address - Fax:
Practice Address - Street 1:3040 UNIVERSITY AVE STE 1400
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3381
Practice Address - Country:US
Practice Address - Phone:304-285-7216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0006470183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVRP0006470OtherWV BOP ISSUED PHARMACY LICENSE