Provider Demographics
NPI:1477938181
Name:MRNB INC
Entity Type:Organization
Organization Name:MRNB INC
Other - Org Name:TRIVILLIAN'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER,VP
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-654-0081
Mailing Address - Street 1:215 35TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1318
Mailing Address - Country:US
Mailing Address - Phone:304-343-8621
Mailing Address - Fax:304-343-1015
Practice Address - Street 1:215 35TH ST SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1318
Practice Address - Country:US
Practice Address - Phone:304-343-8621
Practice Address - Fax:304-343-1015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
WVSP05524953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2153439OtherPK