Healthcare Provider Details

I. General information

NPI: 1376623629
Provider Name (Legal Business Name): ALVA DANIEL HOWARD BOSTICK RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

549 S WEST ST
PIKETON OH
45661-0686
US

IV. Provider business mailing address

549 S WEST ST PO BOX 686
PIKETON OH
45661-0686
US

V. Phone/Fax

Practice location:
  • Phone: 740-289-2269
  • Fax: 740-289-4586
Mailing address:
  • Phone: 740-289-2269
  • Fax: 740-289-4586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03310471
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: