=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629386719
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARCELLA ELLEN HAMRIC RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2010
-----------------------------------------------------
Last Update Date | 09/22/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | RR 3 BOX 3186
-----------------------------------------------------
City | KEYSER
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26726-9415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-788-5931
-----------------------------------------------------
Fax | 304-788-9765
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | RR 1 BOX 187 PARRILL HOLLOW ROAD
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26710-9622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-289-5255
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP0005456
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------