Healthcare Provider Details

I. General information

NPI: 1548631963
Provider Name (Legal Business Name): JITE URHIE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2015
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 HARPER RD
BECKLEY WV
25801-3375
US

IV. Provider business mailing address

634 MANOR DR
BECKLEY WV
25801-2551
US

V. Phone/Fax

Practice location:
  • Phone: 304-252-1111
  • Fax: 304-252-1122
Mailing address:
  • Phone: 304-521-7848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0008774
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: