Provider Demographics
NPI:1982950598
Name:NELSON, PAUL KERWIN III (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KERWIN
Last Name:NELSON
Suffix:III
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 1:31 MIDWAY ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-3246
Mailing Address - Country:US
Mailing Address - Phone:276-642-0032
Mailing Address - Fax:276-642-0036
Practice Address - Street 1:31 MIDWAY ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3246
Practice Address - Country:US
Practice Address - Phone:276-642-0032
Practice Address - Fax:276-642-0036
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022115921835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist