Healthcare Provider Details

I. General information

NPI: 1053257428
Provider Name (Legal Business Name): JODI DOTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MACCORKLE AVE
SAINT ALBANS WV
25177-1825
US

IV. Provider business mailing address

452 TYLER WAY
SCOTT DEPOT WV
25560-9399
US

V. Phone/Fax

Practice location:
  • Phone: 571-205-1977
  • Fax:
Mailing address:
  • Phone: 571-205-1977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0008086
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: