Healthcare Provider Details

I. General information

NPI: 1306293121
Provider Name (Legal Business Name): DENISE ELIZABETH CANBY RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2016
Last Update Date: 05/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 BUTLER AVE
MARTINSBURG WV
25405-9990
US

IV. Provider business mailing address

510 BUTLER AVE
MARTINSBURG WV
25405-9990
US

V. Phone/Fax

Practice location:
  • Phone: 800-817-3807
  • Fax: 304-262-4888
Mailing address:
  • Phone: 304-263-0811
  • Fax: 304-262-4888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202211373
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH18952
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH39372
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: