Organization
MEDBROOK MEDICAL ASSOCIATES INC
Active
Other names
MEDBROOK MEDICAL ASSOCI INC PHCY
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY NELSON MD (MEDICAL DIRECTOR/ PRESIDENT)
(304) 842-7186
Entity
Organization
Contact information
Practice address
1370 JOHNSON AVE, BRIDGEPORT, WV 26330-1492
(304) 842-4233
(304) 842-2574
Mailing address
1370 JOHNSON AVE, BRIDGEPORT, WV 26330-1492
(304) 842-4233
(304) 842-2574
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
SP0552291
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5012048
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
6003063000
—
WV
Enumeration date
07/24/2006
Last updated
08/11/2010
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