Provider Demographics
NPI:1881706299
Name:STORM, ADELE MARIE (RPH)
Entity type:Individual
Prefix:
First Name:ADELE
Middle Name:MARIE
Last Name:STORM
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 1:406 HAZLETT AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6925
Mailing Address - Country:US
Mailing Address - Phone:304-277-4654
Mailing Address - Fax:304-845-0391
Practice Address - Street 1:115 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:MOUNDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26041-1028
Practice Address - Country:US
Practice Address - Phone:304-845-0390
Practice Address - Fax:304-845-0391
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4618183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0143297000Medicaid
0372590001Medicare ID - Type Unspecified