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NPI Code Detail

MEDICARE: CHANGE, INCORPORATED

MEDICARE: CHANGE, INCORPORATED
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail PharmacySP055237WV

General Provider Information

NPI Number : 1528275971
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHANGE, INCORPORATED
Provider Business Mailing Address
First Line : 3136 WEST ST
Second Line :
City : WEIRTON
State : WV
Zip : 26062-4637
Country : US
Telephone Number : 304-797-7733
Fax Number : 304-797-7740
Provider Business Practice Location Address
First Line : 3136 WEST ST
Second Line :
City : WEIRTON
State : WV
Zip : 26062-4637
Country : US
Telephone Number : 304-797-7733
Fax Number : 304-797-7740
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : JUDY L RAVEAUX
Credential :
Telephone Number : 304-797-7733
Provider Enumeration Date : 05/16/2007
Last Update Date : 02/11/2008

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Directions to “CHANGE, INCORPORATED ” Practice Location

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