Healthcare Provider Details

I. General information

NPI: 1821230376
Provider Name (Legal Business Name): LEE AARON GWINN RPH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 03/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 N JEFFERSON ST
LEWISBURG WV
24901-9504
US

IV. Provider business mailing address

840 N JEFFERSON ST
LEWISBURG WV
24901-9504
US

V. Phone/Fax

Practice location:
  • Phone: 304-647-1377
  • Fax: 304-647-9772
Mailing address:
  • Phone: 304-647-1377
  • Fax: 304-647-9772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0006177
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: