Individual
AUTUMN LEE STALEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
120 PROFESSIONAL PL, BRIDGEPORT, WV 26330-4599
(681) 456-6195
Mailing address
120 PROFESSIONAL PL, BRIDGEPORT, WV 26330-4599
(681) 456-6195
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP0013756
WV
Other
Enumeration date
09/01/2023
Last updated
09/01/2023
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