Healthcare Provider Details

I. General information

NPI: 1235591884
Provider Name (Legal Business Name): LAURA RHOADES PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 W CHURCH ST
FAIRCHANCE PA
15436-1137
US

IV. Provider business mailing address

308 TRANQUILITY WAY
MORGANTOWN WV
26508-8639
US

V. Phone/Fax

Practice location:
  • Phone: 724-564-7817
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP441936
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0007016
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: