Provider Demographics
NPI:1740550474
Name:MCDOUGLE, BARRY
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:MCDOUGLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 CHURCH ST S
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271-1615
Mailing Address - Country:US
Mailing Address - Phone:304-372-1606
Mailing Address - Fax:304-372-1607
Practice Address - Street 1:509 CHURCH ST S
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271-1615
Practice Address - Country:US
Practice Address - Phone:304-372-1606
Practice Address - Fax:304-372-1607
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0003763183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist