Healthcare Provider Details

I. General information

NPI: 1851386031
Provider Name (Legal Business Name): NEW RIVER HEALTH ASSOCIATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 SCARBRO RD
SCARBRO WV
25917
US

IV. Provider business mailing address

497 MALL RD
OAK HILL WV
25901-6216
US

V. Phone/Fax

Practice location:
  • Phone: 304-469-3424
  • Fax: 304-465-2266
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberSP0552251
License Number StateWV

VIII. Authorized Official

Name: MARISSA JOHNSON
Title or Position: CREDENTIALING
Credential:
Phone: 304-469-2905