Healthcare Provider Details

I. General information

NPI: 1114804242
Provider Name (Legal Business Name): IAN PLETKA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 OAK ST
KENOVA WV
25530-1215
US

IV. Provider business mailing address

1792 ARLINGTON BLVD
HUNTINGTON WV
25705-2705
US

V. Phone/Fax

Practice location:
  • Phone: 304-453-3504
  • Fax:
Mailing address:
  • Phone: 304-634-7073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0014860
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: