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General NPI Number Information
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NPI Number | 1225386188
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Entity Type | Individual
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Provider Name | GWENDOLINN LOUISE STAUD PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/27/2012
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Last Update Date | 08/27/2012
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Provider Practice Location Address
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Address Line | 300 STATE ROUTE 20
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City | PINE GROVE
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State | WV
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Zip | 26419
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Country | US
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Telephone | 304-889-3131
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Fax | 304-889-3315
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Provider Business Mailing Address
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Address Line | PO BOX 389
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City | PINE GROVE
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State | WV
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Zip | 26419-0389
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Country | US
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Telephone | 304-889-3131
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Fax | 304-889-3315
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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 | RP00007886
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License Number State | WV
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