Healthcare Provider Details

I. General information

NPI: 1982950598
Provider Name (Legal Business Name): PAUL KERWIN NELSON III PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 MIDWAY ST
BRISTOL VA
24201-3246
US

IV. Provider business mailing address

31 MIDWAY ST
BRISTOL VA
24201-3246
US

V. Phone/Fax

Practice location:
  • Phone: 276-642-0032
  • Fax: 276-642-0036
Mailing address:
  • Phone: 276-642-0032
  • Fax: 276-642-0036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0202211592
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: