MEDICARE: MR. BILLY DURAND MADDOX RPH

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
1	183500000X	Pharmacist	07216	NC

General Provider Information

NPI Number	:	1407149230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BILLY DURAND MADDOX RPH

Provider Business Mailing Address
First Line	:	202 E RALEIGH ST STE A
Second Line	:
City	:	SILER CITY
State	:	NC
Zip	:	27344-3559
Country	:	US
Telephone Number	:	919-663-5541
Fax Number	:	919-663-5577

Provider Business Practice Location Address
First Line	:	202 E RALEIGH ST STE A
Second Line	:
City	:	SILER CITY
State	:	NC
Zip	:	27344-3559
Country	:	US
Telephone Number	:	919-663-5541
Fax Number	:	919-663-5577

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2011
Last Update Date	:	05/26/2011

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