Individual
MARY ELLIOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
200 EMILY DR, CLARKSBURG, WV 26301-5500
(304) 918-6056
Mailing address
11 OVERLOOK DR, BRIDGEPORT, WV 26330-1021
(304) 365-0921
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH0007700
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RP0007700
BOARD OF PHARMACY
WV
Enumeration date
07/31/2020
Last updated
07/31/2020
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