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General NPI Number Information
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NPI Number | 1194325696
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Entity Type | Individual
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Provider Name | RICHARD DENNIS BORDER JR.
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Gender | Male
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Dates
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Enumeration Date | 10/26/2020
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Last Update Date | 10/26/2020
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Provider Practice Location Address
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Address Line | 10 WALMART DR
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City | MOUNDSVILLE
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State | WV
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Zip | 26041-1187
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Country | US
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Telephone | 304-843-1507
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Fax |
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Provider Business Mailing Address
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Address Line | 280 BROWNS RUN RD
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City | WHEELING
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State | WV
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Zip | 26003-9464
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Country | US
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Telephone | 304-559-3885
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03226299
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP0006749
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License Number State | WV
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