Provider Demographics
NPI:1992076459
Name:ARCO, SAMUEL ANTHONY (RPH)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:ANTHONY
Last Name:ARCO
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 1:701 LEE ST E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1706
Mailing Address - Country:US
Mailing Address - Phone:304-720-8341
Mailing Address - Fax:304-720-8343
Practice Address - Street 1:701 LEE ST E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1706
Practice Address - Country:US
Practice Address - Phone:304-720-8341
Practice Address - Fax:304-720-8343
Is Sole Proprietor?:No
Enumeration Date:2012-01-15
Last Update Date:2012-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3251183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist