Organization
PREMISE HEALTH
Active
Other names
The Living Well Health Center - Downtown Plaza
Organization subpart
No
Provider details
NPI number
Authorized official
JOYCE JENSEN (DIRECTOR SITE OPERATIONS)
(904) 401-1175
Entity
Organization
Contact information
Practice address
401 N MAIN ST, WINSTON SALEM, NC 27101-3804
(336) 741-5106
Mailing address
475 SUMMIT SQUARE BLVD, WINSTON SALEM, NC 27105-1485
(336) 377-3979
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
12513
NC
3336C0002X
Clinic Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2160657
PK
—
Enumeration date
06/29/2016
Last updated
06/29/2016
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