Individual
POLLY NICOLE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARM D
Contact information
Practice address
471 MAIN ST, MADISON, WV 25130-1223
(304) 369-5170
Mailing address
467 MAIN ST, MADISON, WV 25130-2200
(304) 369-5170
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP0007932
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RP0007932
WV PHAMACIST LICENSE
WV
Enumeration date
03/21/2019
Last updated
04/12/2019
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