Provider Demographics
NPI:1306145248
Name:WORKMAN, BRIAN KENNETH
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:KENNETH
Last Name:WORKMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 KEYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-1032
Mailing Address - Country:US
Mailing Address - Phone:304-881-9685
Mailing Address - Fax:
Practice Address - Street 1:14 KEYSTONE DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-1032
Practice Address - Country:US
Practice Address - Phone:304-881-9685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVIN0005987183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist