Healthcare Provider Details

I. General information

NPI: 1306293303
Provider Name (Legal Business Name): DR. MICHAEL DURST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5717 MACCORKLE AVE SE
CHARLESTON WV
25304-2803
US

IV. Provider business mailing address

5717 MACCORKLE AVE SE
CHARLESTON WV
25304-2803
US

V. Phone/Fax

Practice location:
  • Phone: 304-925-8400
  • Fax:
Mailing address:
  • Phone: 304-925-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03438430
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRP0011165
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: