Provider Demographics
NPI:1922412014
Name:MRNB INC
Entity Type:Organization
Organization Name:MRNB INC
Other - Org Name:ROSS DRUG OF CEREDO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
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:304-908-5586
Mailing Address - Street 1:US ROUTE 60 AT 4TH ST
Mailing Address - Street 2:STORE ROOM 20
Mailing Address - City:CEREDO
Mailing Address - State:WV
Mailing Address - Zip Code:25507
Mailing Address - Country:US
Mailing Address - Phone:304-908-5586
Mailing Address - Fax:304-908-5587
Practice Address - Street 1:US ROUTE 60 AT 4TH ST
Practice Address - Street 2:STORE ROOM 20
Practice Address - City:CEREDO
Practice Address - State:WV
Practice Address - Zip Code:25507
Practice Address - Country:US
Practice Address - Phone:304-908-5586
Practice Address - Fax:304-908-5587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WVSP05524733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145126OtherPK