Provider Demographics
NPI:1699155481
Name:FORRER, DAVID WETHERELL
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WETHERELL
Last Name:FORRER
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 1:329 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:WV
Mailing Address - Zip Code:26170-1005
Mailing Address - Country:US
Mailing Address - Phone:304-684-3784
Mailing Address - Fax:304-684-2358
Practice Address - Street 1:329 2ND ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:WV
Practice Address - Zip Code:26170-1005
Practice Address - Country:US
Practice Address - Phone:304-684-3784
Practice Address - Fax:304-684-2358
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0004588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist