Provider Demographics
NPI:1992292379
Name:MCDILDA, ALAN RUSSELL II (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:RUSSELL
Last Name:MCDILDA
Suffix:II
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 1:425 CAMDEN RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704-2708
Mailing Address - Country:US
Mailing Address - Phone:304-429-5544
Mailing Address - Fax:
Practice Address - Street 1:425 CAMDEN RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704-2708
Practice Address - Country:US
Practice Address - Phone:304-429-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03129921183500000X
KY015864183500000X
WVRP0007171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY015864OtherKENTUCKY BOARD OF PHARMACY
OH03129921OtherOHIO BOARD OF PHARMACY
WVRP0007171OtherWEST VIRGINIA BOARD OF PHARMACY