Provider Demographics
NPI:1982470951
Name:AMENTE, FIRAOL GERMAN
Entity Type:Individual
Prefix:
First Name:FIRAOL GERMAN
Middle Name:
Last Name:AMENTE
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 1:2524 DISTRICT DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3828
Mailing Address - Country:US
Mailing Address - Phone:929-284-9340
Mailing Address - Fax:
Practice Address - Street 1:897 CHESTNUT RIDGE RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2704
Practice Address - Country:US
Practice Address - Phone:304-598-2534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0013802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist