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General NPI Number Information
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NPI Number | 1023335510
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF CHARLESTON
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Dates
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Enumeration Date | 04/23/2010
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Last Update Date | 05/26/2010
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Provider Practice Location Address
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Address Line | 2500 CHEROKEE AVE
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City | CHARLESTON
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State | WV
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Zip | 25304
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Country | US
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Telephone | 304-357-4385
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 MACCORKLE AVE SE PHARMUC-SCHOOL OF PHARMACY
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City | CHARLESTON
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State | WV
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Zip | 25304-1045
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | CLETA MAE HARLESS
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Credential | MBA
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Telephone | 304-357-4736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | OP0552215
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License Number State | WV
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