1790097509 NPI number — MRS. ELIZABETH OLAIDE JEGEDE PHARMACIST

Table of content: MRS. ELIZABETH OLAIDE JEGEDE PHARMACIST (NPI 1790097509)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790097509 NPI number — MRS. ELIZABETH OLAIDE JEGEDE PHARMACIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JEGEDE
Provider First Name:
ELIZABETH
Provider Middle Name:
OLAIDE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHARMACIST
Provider Gender Code:
F

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:
1790097509
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6147 CHAMBERLAIN PL
Provider Second Line Business Mailing Address:
APT 201
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27103-7148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-766-0066
Provider Business Mailing Address Fax Number:
336-766-0066

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6475 OLD HIGHWAY 52
Provider Second Line Business Practice Location Address:
RITE AID PHARMACY
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-731-3033
Provider Business Practice Location Address Fax Number:
336-731-0273
Provider Enumeration Date:
07/09/2010

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:  20871 , 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)





Copyright © 2007-2024 www.npivalidator.com