MEDICARE: DR. GREGG MICHAEL STERN PHARMACIST

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	5254	WV

General Provider Information

NPI Number	:	1780988022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGG MICHAEL STERN PHARMACIST

Provider Business Mailing Address
First Line	:	PO BOX 577
Second Line	:
City	:	SMITHERS
State	:	WV
Zip	:	25186-0577
Country	:	US
Telephone Number	:	304-442-2152
Fax Number	:	304-442-5159

Provider Business Practice Location Address
First Line	:	505 VIRGINIA AVE.
Second Line	:
City	:	SMITHERS
State	:	WV
Zip	:	25186-0577
Country	:	US
Telephone Number	:	304-442-2152
Fax Number	:	304-442-5159

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

Provider Enumeration Date	:	12/30/2010
Last Update Date	:	12/30/2010

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