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General NPI Number Information
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NPI Number | 1356649297
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Entity Type | Individual
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Provider Name | LEA ANN PHARES R.PH.
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Gender | Female
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Dates
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Enumeration Date | 03/02/2011
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Last Update Date | 02/11/2021
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Provider Practice Location Address
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Address Line | 902 N LEWIS ST
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City | GLENVILLE
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State | WV
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Zip | 26351-1323
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Country | US
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Telephone | 304-462-4438
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Fax | 304-462-7624
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Provider Business Mailing Address
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Address Line | 407 SPRUCE RUN RD
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City | GLENVILLE
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State | WV
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Zip | 26351-8145
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Country | US
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Telephone | 304-462-8950
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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 | 6143
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License Number State | WV
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