Provider Demographics
NPI:1306975057
Name:BARRICK, BRENT KILES (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:KILES
Last Name:BARRICK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 72 BOX 396
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-9604
Mailing Address - Country:US
Mailing Address - Phone:304-788-6760
Mailing Address - Fax:304-788-9765
Practice Address - Street 1:RR 3 BOX 3186
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-9415
Practice Address - Country:US
Practice Address - Phone:304-788-5931
Practice Address - Fax:304-788-9765
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0006801183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist