1649515362 NPI number — PIEDMONT PHARMACY SOLUTIONS, INC

Table of content: (NPI 1649515362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649515362 NPI number — PIEDMONT PHARMACY SOLUTIONS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIEDMONT PHARMACY SOLUTIONS, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PIEDMONT PHARMACY NATIONS FORD
Provider Other Organization Name Type Code:
3
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:
1649515362
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 78317
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28271-7030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-971-9880
Provider Business Mailing Address Fax Number:
704-971-9881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9040 NATIONS FORD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28273-5716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-971-9880
Provider Business Practice Location Address Fax Number:
704-971-9881
Provider Enumeration Date:
12/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
OBUSEH
Authorized Official First Name:
SONY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
704-971-9880

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X , with the licence number:  10488 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X , with the licence number: 10488 , 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)

  • Identifier: 0602494 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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