Healthcare Provider Details

I. General information

NPI: 1114060555
Provider Name (Legal Business Name): DARLA D BEANE R.PH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 SENECA TRL
RONCEVERTE WV
24970-1340
US

IV. Provider business mailing address

HC 81 BOX 106A
LEWISBURG WV
24901-9528
US

V. Phone/Fax

Practice location:
  • Phone: 304-645-1892
  • Fax: 304-645-1891
Mailing address:
  • Phone: 304-645-4287
  • Fax: 304-645-1891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0006238
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: