Individual
BRADLEY BALESTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1212 LAFAYETTE AVE, MOUNDSVILLE, WV 26041-2315
(304) 845-8116
Mailing address
1212 LAFAYETTE AVE, MOUNDSVILLE, WV 26041-2315
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
03335261
OH
183500000X
Pharmacist
Primary
RP0009303
WV
Other
Enumeration date
04/23/2016
Last updated
04/23/2016
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