Individual
SHELLY LYNN SPROUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6401 SISSONVILLE DR, CHARLESTON, WV 25312-9463
(304) 984-9597
Mailing address
RR 1 BOX 94, STATTS MILLS, WV 25271-9719
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP0005947
WV
Other
Enumeration date
03/07/2011
Last updated
03/07/2011
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