Provider Demographics
NPI:1427268184
Name:MOURAT, JOHN IRVIN (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:IRVIN
Last Name:MOURAT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 HOLIDAY DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-9479
Mailing Address - Country:US
Mailing Address - Phone:740-376-9443
Mailing Address - Fax:
Practice Address - Street 1:1506 ELIZABETH PIKE
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:WV
Practice Address - Zip Code:26150
Practice Address - Country:US
Practice Address - Phone:304-489-9086
Practice Address - Fax:304-489-2687
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0005422183500000X
OH03-2-17873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist