Individual
JESSICA D BOOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
300 W MAIN ST, BRIDGEPORT, WV 26330-1751
(304) 842-3131
Mailing address
4110 KAUSTIN DR, MORGANTOWN, WV 26501-7229
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
RP0011851
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RP0011851
PHARMACIST LICENSE
WV
Enumeration date
12/02/2019
Last updated
12/02/2019
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