Individual
FAE CLEDA VINCENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMACIST
Contact information
Practice address
2800 MEADOWBROOK MALL, BRIDGEPORT, WV 26330-9795
(304) 842-7779
Mailing address
6945 BEVERLY PIKE, FAIRMONT, WV 26554-7852
(304) 366-8297
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
3153
WV
Other
Enumeration date
06/19/2013
Last updated
06/19/2013
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