Healthcare Provider Details

I. General information

NPI: 1255817060
Provider Name (Legal Business Name): MERVAN NEWBOLD PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2018
Last Update Date: 04/19/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MED CENTER DR
CLARKSBURG WV
26301-4155
US

IV. Provider business mailing address

1 MEDICAL CENTER DR
CLARKSBURG WV
26301
US

V. Phone/Fax

Practice location:
  • Phone: 304-623-3461
  • Fax:
Mailing address:
  • Phone: 304-326-7873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP8067
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberP8067
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberP8067
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: