=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124506993
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALLISON DELANCEY PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2018
-----------------------------------------------------
Last Update Date | 08/02/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 MATTHEW ST STE 100
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45750-1635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-434-0140
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1020 PIKE RD
-----------------------------------------------------
City | ELLENBORO
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26346-6724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-483-4486
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP0010624
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------