Provider Demographics
NPI:1427712702
Name:NEWBERRY, ROBERT EDWARD JR (PHARMD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:EDWARD
Last Name:NEWBERRY
Suffix:JR
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:PO BOX 481
Mailing Address - Street 2:
Mailing Address - City:RODERFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24881-0481
Mailing Address - Country:US
Mailing Address - Phone:304-938-6141
Mailing Address - Fax:
Practice Address - Street 1:1229 STAFFORD DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2465
Practice Address - Country:US
Practice Address - Phone:304-487-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-23
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0012717333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy