MEDICARE: PERRY P DIAMADUROS 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	6025	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3400316	OTHER	NC	NCPDP

General Provider Information

NPI Number	:	1437282738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PERRY P DIAMADUROS RPH

Provider Business Mailing Address
First Line	:	1123 CAMEO CT
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-1001
Country	:	US
Telephone Number	:	704-998-6216
Fax Number	:	704-998-6216

Provider Business Practice Location Address
First Line	:	4220 N TRYON ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28206-2069
Country	:	US
Telephone Number	:	704-596-8233
Fax Number	:	704-921-1180

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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Directions to “ PERRY P DIAMADUROS RPH” Practice Location

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