Provider Demographics
NPI:1366819211
Name:BRINK, JUSTIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:BRINK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 POPPER ST
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-5613
Mailing Address - Country:US
Mailing Address - Phone:609-290-1275
Mailing Address - Fax:
Practice Address - Street 1:889 VENTURE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-7311
Practice Address - Country:US
Practice Address - Phone:304-292-2787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0009291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVRP0009291OtherWEST VIRGINIA BOARD OF PHARMACY