Individual
HOUSTON MAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
2100 GATEWAY CENTRE BLVD, 300, MORRISVILLE, NC 27560-6228
(919) 460-3967
Mailing address
2100 GATEWAY CENTRE BLVD, 300, MORRISVILLE, NC 27560-6228
(919) 460-3967
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
25986
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25986
NCBOP
NC
Enumeration date
06/29/2016
Last updated
06/29/2016
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