Individual
HALEY NICOLE ILCEWICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 MEDICAL CENTER DR DEPT OF, MORGANTOWN, WV 26506-1200
(304) 598-4148
Mailing address
PO BOX 8045, MORGANTOWN, WV 26506-8045
(304) 598-4148
(304) 598-4073
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP0010530
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RP0010530
PHARMACIST
WV
Enumeration date
01/17/2019
Last updated
01/17/2019
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