Healthcare Provider Details

I. General information

NPI: 1205656782
Provider Name (Legal Business Name): LANCE GOSSETT R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PARK
WHEELING WV
26003-6379
US

IV. Provider business mailing address

13 BEEHAVEN DR
WHEELING WV
26003-4901
US

V. Phone/Fax

Practice location:
  • Phone: 304-243-3388
  • Fax: 304-243-6422
Mailing address:
  • Phone: 724-554-2462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03318779
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0004854
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: