Provider Demographics
NPI:1770733982
Name:SHREWSBURY, JEANETTE D (RPH)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:D
Last Name:SHREWSBURY
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 1:908 SCARBRO RD
Mailing Address - Street 2:PO BOX 337
Mailing Address - City:SCARBRO
Mailing Address - State:WV
Mailing Address - Zip Code:25917-8837
Mailing Address - Country:US
Mailing Address - Phone:304-469-3424
Mailing Address - Fax:304-929-6776
Practice Address - Street 1:908 SCARBRO ROAD
Practice Address - Street 2:
Practice Address - City:SCARBRO
Practice Address - State:WV
Practice Address - Zip Code:25917-0337
Practice Address - Country:US
Practice Address - Phone:304-469-3424
Practice Address - Fax:304-929-6776
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0006571183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5008330OtherNCPDP