Healthcare Provider Details

I. General information

NPI: 1760958045
Provider Name (Legal Business Name): TERRI LEE HOVATTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 GORMAN AVE
ELKINS WV
26241-3181
US

IV. Provider business mailing address

812 GORMAN AVE
ELKINS WV
26241-3181
US

V. Phone/Fax

Practice location:
  • Phone: 304-636-6767
  • Fax: 304-637-4714
Mailing address:
  • Phone: 304-636-6767
  • Fax: 304-637-4714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0003509
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: