NPI 1003144262

Carney Jerrod Broadwater, PHARMD

Practitioner Pharmacist Ronceverte, WV

Practice location

Address: 370 Seneca Trl, Ronceverte, WV 24970-1340
Phone: (304) 645-1890
Fax: (304) 645-1891
Mailing address: 356 Seneca Trl, Ronceverte, WV 24970-1320

Registered specialties

Pharmacist Primary

Pharmacy Service Providers Taxonomy 183500000X Licence RP0007192 (WV)

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Registry record

NPI: 1003144262
Entity type: Individual
Sex (as registered): Male
NPI issued: 30 Nov 2009
Record last updated: 30 Nov 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.