Provider Demographics
NPI:1487902045
Name:MCQUAIN, DAVID MICHAEL (RPH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:MCQUAIN
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 1:433 CRAIGSVILLE ROAD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CRAIGSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26205
Mailing Address - Country:US
Mailing Address - Phone:304-742-5001
Mailing Address - Fax:304-742-5002
Practice Address - Street 1:433 CRAIGSVILLE ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:CRAIGSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26205
Practice Address - Country:US
Practice Address - Phone:304-742-5001
Practice Address - Fax:304-742-5002
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV006062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist