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General NPI Number Information
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NPI Number | 1891300760
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Entity Type | Individual
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Provider Name | SLADE MATHEW MCDOWELL RPH
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Gender | Male
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Dates
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Enumeration Date | 09/09/2020
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Last Update Date | 09/09/2020
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Provider Practice Location Address
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Address Line | 74 JOSHUA M FREEMAN BLVD
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City | RANSON
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State | WV
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Zip | 25438-5694
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Country | US
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Telephone | 304-206-6923
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Fax |
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Provider Business Mailing Address
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Address Line | 292 POSTING WAY
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City | CHARLES TOWN
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State | WV
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Zip | 25414-9324
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Country | US
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Telephone |
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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 | RP0012250
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License Number State | WV
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