Provider Demographics
NPI:1700347572
Name:ALDRIDGE, ELISABETH ANN (RPH)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:ANN
Last Name:ALDRIDGE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 GENTLE BREEZE DR
Mailing Address - Street 2:
Mailing Address - City:CHAPMANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25508-5809
Mailing Address - Country:US
Mailing Address - Phone:304-752-2353
Mailing Address - Fax:304-583-9929
Practice Address - Street 1:124 MAIN ST
Practice Address - Street 2:
Practice Address - City:MAN
Practice Address - State:WV
Practice Address - Zip Code:25635-1212
Practice Address - Country:US
Practice Address - Phone:304-583-9910
Practice Address - Fax:304-583-9929
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0006331183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist