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Individual

DR. CARNEY JERROD BROADWATER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHARMD

Contact information

Practice address
370 SENECA TRL, RONCEVERTE, WV 24970-1340
(304) 645-1890
(304) 645-1891
Mailing address
356 SENECA TRL, RONCEVERTE, WV 24970-1320

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP0007192
WV

Other

Enumeration date
11/30/2009
Last updated
11/30/2009
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