Healthcare Provider Details

I. General information

NPI: 1902968019
Provider Name (Legal Business Name): MEGAN MICHELE DISERIO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 COLLIERS WAY
WEIRTON WV
26062-5053
US

IV. Provider business mailing address

627 WABASH DR
FOLLANSBEE WV
26037-1249
US

V. Phone/Fax

Practice location:
  • Phone: 304-723-6331
  • Fax:
Mailing address:
  • Phone: 304-527-2744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0006882
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: