Healthcare Provider Details

I. General information

NPI: 1144212408
Provider Name (Legal Business Name): DEFELICECARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 SIXTEENTH ST STE 200
WHEELING WV
26003-3660
US

IV. Provider business mailing address

76 SIXTEENTH ST STE 200
WHEELING WV
26003-3660
US

V. Phone/Fax

Practice location:
  • Phone: 304-232-4210
  • Fax: 304-232-4213
Mailing address:
  • Phone: 304-232-4210
  • Fax: 304-232-4213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberSP0552381
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LESLIE DEFELICE
Title or Position: PRESIDENT & CEO
Credential:
Phone: 304-232-4210