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NPI Code Detail

MEDICARE: MR. BLAKE GRIMES BAREFOOT R.PH.

MEDICARE: MR. BLAKE GRIMES BAREFOOT R.PH.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist12093ND

General Provider Information

NPI Number : 1255626065
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BLAKE GRIMES BAREFOOT R.PH.
Provider Business Mailing Address
First Line : 5167 NICHOLAS CRK
Second Line :
City : WILMINGTON
State : NC
Zip : 28409-2356
Country : US
Telephone Number : 910-452-7587
Fax Number : 910-395-0749
Provider Business Practice Location Address
First Line : 4711 NEW CENTRE DR
Second Line :
City : WILMINGTON
State : NC
Zip : 28405-3442
Country : US
Telephone Number : 910-395-0749
Fax Number : 910-395-0749
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2011
Last Update Date : 06/09/2011

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