Provider Demographics
NPI:1104117605
Name:WRIGHT, ROSE
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 E DUPONT AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:BELLE
Mailing Address - State:WV
Mailing Address - Zip Code:25015-1842
Mailing Address - Country:US
Mailing Address - Phone:304-949-6237
Mailing Address - Fax:
Practice Address - Street 1:2700 E DUPONT AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:BELLE
Practice Address - State:WV
Practice Address - Zip Code:25015-1842
Practice Address - Country:US
Practice Address - Phone:304-949-6237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0007454183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist