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General NPI Number Information
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NPI Number | 1245421312
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Entity Type | Organization
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Legal Business Name | GRANT MEMORIAL HOSPITAL HOME INFUSION THERAPY SERVICES
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 08/05/2007
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Provider Practice Location Address
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Address Line | RT 4 AND 28
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City | PETERSBURG
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State | WV
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Zip | 26847
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Country | US
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Telephone | 304-257-1026
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Fax | 304-257-9622
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Provider Business Mailing Address
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Address Line | RT 4 AND 28
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City | PETERSBURG
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State | WV
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Zip | 26847
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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 | PIC
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Name | DAVID BROSH
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Credential | RPH
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Telephone | 304-257-1026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number | OP0551225
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License Number State | WV
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