Provider Demographics
NPI:1669925483
Name:BOSTIC, CIARA (PHARMD)
Entity type:Individual
Prefix:
First Name:CIARA
Middle Name:
Last Name:BOSTIC
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 1:2 WINFIELD AVE
Mailing Address - Street 2:APARTMENT 4
Mailing Address - City:WINFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:25213-7792
Mailing Address - Country:US
Mailing Address - Phone:740-645-2585
Mailing Address - Fax:
Practice Address - Street 1:3114 TEAYS VALLEY RD
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-1335
Practice Address - Country:US
Practice Address - Phone:304-562-7138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0009790183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist