MEDICARE: MR. RICHARD DIPASQUALE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	WV0004644	WV

General Provider Information

NPI Number	:	1528462850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD DIPASQUALE

Provider Business Mailing Address
First Line	:	800 GRAND CENTRAL AVE
Second Line	:
City	:	VIENNA
State	:	WV
Zip	:	26105-2150
Country	:	US
Telephone Number	:	304-295-4506
Fax Number	:	304-295-9436

Provider Business Practice Location Address
First Line	:	800 GRAND CENTRAL AVE
Second Line	:
City	:	VIENNA
State	:	WV
Zip	:	26105-2150
Country	:	US
Telephone Number	:	304-295-4506
Fax Number	:	304-295-9436

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2014
Last Update Date	:	10/15/2014

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Directions to “ MR. RICHARD DIPASQUALE ” Practice Location

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