Provider Demographics
NPI:1912049180
Name:ADKINS, RODNEY RANDALL (RPH)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:RANDALL
Last Name:ADKINS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MAN
Mailing Address - State:WV
Mailing Address - Zip Code:25635-1107
Mailing Address - Country:US
Mailing Address - Phone:304-583-2489
Mailing Address - Fax:
Practice Address - Street 1:37 US ROUTE 80
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:WV
Practice Address - Zip Code:25621-1537
Practice Address - Country:US
Practice Address - Phone:304-664-8883
Practice Address - Fax:304-664-9236
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0002989183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1089910001Medicare NSC