Healthcare Provider Details

I. General information

NPI: 1528136850
Provider Name (Legal Business Name): EDDIE G THORNHILL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 STOLLINGS AVE
LOGAN WV
25601-4010
US

IV. Provider business mailing address

177 NEIGHBERT AVE
LOGAN WV
25601
US

V. Phone/Fax

Practice location:
  • Phone: 304-752-0082
  • Fax:
Mailing address:
  • Phone: 304-752-2523
  • Fax: 304-752-9600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0004769
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: