Provider Demographics
NPI:1184105561
Name:GLADWELL, IAN (PHARMD)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:GLADWELL
Suffix:
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 1:38 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26261-1106
Mailing Address - Country:US
Mailing Address - Phone:304-846-0180
Mailing Address - Fax:304-846-0182
Practice Address - Street 1:38 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHWOOD
Practice Address - State:WV
Practice Address - Zip Code:26261-1106
Practice Address - Country:US
Practice Address - Phone:304-846-0180
Practice Address - Fax:304-846-0182
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0011138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist