Healthcare Provider Details

I. General information

NPI: 1679546378
Provider Name (Legal Business Name): VIOLA MARIE ROUSH R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 KANAWHA AVE
RAINELLE WV
25962-1013
US

IV. Provider business mailing address

306 DAVIS ST
LEWISBURG WV
24901-1716
US

V. Phone/Fax

Practice location:
  • Phone: 304-438-6186
  • Fax: 304-438-6185
Mailing address:
  • Phone: 304-645-7671
  • Fax: 304-438-6185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0005431
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: