1104149665 NPI number — DAVID LOUIS DEMEULEMEESTER RPH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104149665 NPI number — DAVID LOUIS DEMEULEMEESTER RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEMEULEMEESTER
Provider First Name:
DAVID
Provider Middle Name:
LOUIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104149665
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
206 SPRUCE RD
Provider Second Line Business Mailing Address:
PO BOX 1685
Provider Business Mailing Address City Name:
BLOWING ROCK
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28605-6267
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-295-9567
Provider Business Mailing Address Fax Number:
828-295-9567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2814 BLOWING ROCK ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOONE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-268-0727
Provider Business Practice Location Address Fax Number:
828-268-5093
Provider Enumeration Date:
03/11/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  16954 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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