Healthcare Provider Details

I. General information

NPI: 1134202633
Provider Name (Legal Business Name): RICHARD BROOKS LOSH R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 BUTLER AVE. VA MEDICAL CENTER
MARTINSBURG WV
25401
US

IV. Provider business mailing address

106 FENWICK DR
MARTINSBURG WV
25401-2527
US

V. Phone/Fax

Practice location:
  • Phone: 304-263-0811
  • Fax:
Mailing address:
  • Phone: 304-263-0811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0003515
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: