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General NPI Number Information
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NPI Number | 1780029876
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Entity Type | Individual
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Provider Name | MICHAEL JAMES EBBERT R.PH.
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Gender | Male
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Dates
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Enumeration Date | 05/03/2013
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Last Update Date | 05/03/2013
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Provider Practice Location Address
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Address Line | 3538 TEAYS VALLEY RD
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City | HURRICANE
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State | WV
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Zip | 25526-9054
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Country | US
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Telephone | 304-212-7207
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Fax | 888-808-0795
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Provider Business Mailing Address
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Address Line | 3538 TEAYS VALLEY RD
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City | HURRICANE
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State | WV
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Zip | 25526-9054
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Country | US
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Telephone | 304-212-7207
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Fax | 888-808-0795
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP0004542
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03317167
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License Number State | OH
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