Healthcare Provider Details

I. General information

NPI: 1821907403
Provider Name (Legal Business Name): MARIELLE ELIZABETH FORMENTERA CARTER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIELLE CARTER PHARMD

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SUNCREST TOWN CENTRE DR
MORGANTOWN WV
26505-1820
US

IV. Provider business mailing address

500 SUNCREST TOWN CENTRE DR
MORGANTOWN WV
26505-1820
US

V. Phone/Fax

Practice location:
  • Phone: 304-285-6781
  • Fax:
Mailing address:
  • Phone: 304-285-6781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0015296
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: