=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326168063
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RENEE MARIE POSTLETHWAIT R.PH.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2007
-----------------------------------------------------
Last Update Date | 11/27/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 STADIUM DR
-----------------------------------------------------
City | MORGANTOWN
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26507-0782
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-598-4848
-----------------------------------------------------
Fax | 304-598-4849
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | RR 4 BOX 517
-----------------------------------------------------
City | FAIRMONT
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26554-9349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-598-4848
-----------------------------------------------------
Fax | 304-598-4849
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP0005238
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1835P1200X
-----------------------------------------------------
Taxonomy Name | Pharmacotherapy Pharmacist
-----------------------------------------------------
License Number | RP0005238
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------