Healthcare Provider Details

I. General information

NPI: 1831480102
Provider Name (Legal Business Name): GROWING CHILD OFFICE MEDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 GATEWAY DR
CLAYTON NC
27520-2158
US

IV. Provider business mailing address

PO BOX 90216
RALEIGH NC
27675-0216
US

V. Phone/Fax

Practice location:
  • Phone: 919-585-9001
  • Fax:
Mailing address:
  • Phone: 919-215-0240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number11013
License Number StateNC

VIII. Authorized Official

Name: TONY GURLEY
Title or Position: PHARMACY MANAGER
Credential:
Phone: 919-215-0240