Provider Demographics
NPI:1336401892
Name:EDDY, JEFFREY DAVIS (RPH)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DAVIS
Last Name:EDDY
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 1:2792 KELLER LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26187-8309
Mailing Address - Country:US
Mailing Address - Phone:304-488-4284
Mailing Address - Fax:
Practice Address - Street 1:2792 KELLER LN
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:WV
Practice Address - Zip Code:26187-8309
Practice Address - Country:US
Practice Address - Phone:304-488-4284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH255601835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist