MEDICARE: BIDDLEVILLE-DALEBROOK PHARMACIES

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	3336C0003X	Community/Retail Pharmacy	01796	NC

General Provider Information

NPI Number	:	1932367992
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIDDLEVILLE-DALEBROOK PHARMACIES

Provider Business Mailing Address
First Line	:	2506 BEATTIES FORD RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-4321
Country	:	US
Telephone Number	:	704-392-9199
Fax Number	:

Provider Business Practice Location Address
First Line	:	2506 BEATTIES FORD RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-4321
Country	:	US
Telephone Number	:	704-392-9199
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	GRIFFIN WAKEFIELD
Credential	:
Telephone Number	:	704-392-9199

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	05/27/2008

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