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General NPI Number Information
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NPI Number | 1447338611
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Entity Type | Individual
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Provider Name | KELLY J STETCHOCK PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3805 MACCORKLE AVE SE
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City | CHARLESTON
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State | WV
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Zip | 25304-1527
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Country | US
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Telephone | 304-926-6433
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Fax |
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Provider Business Mailing Address
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Address Line | 203 MARIEL WAY
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City | CHARLESTON
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State | WV
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Zip | 25311-1599
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Country | US
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Telephone | 304-346-9382
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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 | RP0006431
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License Number State | WV
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