MEDICARE: DAVID WETHERELL FORRER

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
1	183500000X	Pharmacist	RP0004588	WV

General Provider Information

NPI Number	:	1699155481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID WETHERELL FORRER

Provider Business Mailing Address
First Line	:	329 2ND ST
Second Line	:
City	:	SAINT MARYS
State	:	WV
Zip	:	26170-1005
Country	:	US
Telephone Number	:	304-684-3784
Fax Number	:	304-684-2358

Provider Business Practice Location Address
First Line	:	329 2ND ST
Second Line	:
City	:	SAINT MARYS
State	:	WV
Zip	:	26170-1005
Country	:	US
Telephone Number	:	304-684-3784
Fax Number	:	304-684-2358

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2015
Last Update Date	:	06/05/2015

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Directions to “ DAVID WETHERELL FORRER ” Practice Location

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