Healthcare Provider Details

I. General information

NPI: 1023618022
Provider Name (Legal Business Name): COURTNEY HOHMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1142 S BRIDGE ST
NEW MARTINSVILLE WV
26155-1508
US

IV. Provider business mailing address

24238 ENERGY HWY
NEW MARTINSVILLE WV
26155-8487
US

V. Phone/Fax

Practice location:
  • Phone: 304-455-6402
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0007076
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: