Provider Demographics
NPI:1053610246
Name:STONE, CONNIE SUE (PHARMD)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:SUE
Last Name:STONE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:LOUDERMILK
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1429 DOGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2309
Mailing Address - Country:US
Mailing Address - Phone:304-282-8250
Mailing Address - Fax:
Practice Address - Street 1:1429 DOGWOOD AVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2309
Practice Address - Country:US
Practice Address - Phone:304-282-8250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV04951183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist