Healthcare Provider Details

I. General information

NPI: 1780231571
Provider Name (Legal Business Name): CAROLINE MARIE PUTNAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 SYCAMORE ST
KENOVA WV
25530-1637
US

IV. Provider business mailing address

1706 SYCAMORE ST
KENOVA WV
25530-1637
US

V. Phone/Fax

Practice location:
  • Phone: 304-933-1327
  • Fax:
Mailing address:
  • Phone: 304-933-1327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: