Healthcare Provider Details

I. General information

NPI: 1497169809
Provider Name (Legal Business Name): MRNB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 COURTYARD LN
BARBOURSVILLE WV
25504
US

IV. Provider business mailing address

2 COURTYARD LN
BARBOURSVILLE WV
25504-1015
US

V. Phone/Fax

Practice location:
  • Phone: 866-201-8712
  • Fax: 866-441-5478
Mailing address:
  • Phone: 304-908-5586
  • Fax: 866-441-5478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberSP0552473
License Number StateWV

VIII. Authorized Official

Name: NATHAN E BARNES
Title or Position: OWNER
Credential:
Phone: 866-201-8712