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General NPI Number Information
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NPI Number | 1598016594
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Entity Type | Individual
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Provider Name | ALISHA JUHREE MAYNARD PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/01/2012
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Last Update Date | 10/01/2012
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Provider Practice Location Address
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Address Line | 2300 MACCORKLE AVE SE
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City | CHARLESTON
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State | WV
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Zip | 25304-1045
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Country | US
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Telephone | 304-896-1322
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 415
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City | LENORE
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State | WV
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Zip | 25676-0415
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Country | US
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Telephone | 304-393-6118
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | IN0006227
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License Number State | WV
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