Healthcare Provider Details

I. General information

NPI: 1013155324
Provider Name (Legal Business Name): MICROPHARM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 01/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 8TH AVE
CRAMERTON NC
28032-1401
US

IV. Provider business mailing address

149 8TH AVE
CRAMERTON NC
28032-1401
US

V. Phone/Fax

Practice location:
  • Phone: 704-824-4401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number04472
License Number StateNC

VIII. Authorized Official

Name: LEE ISLEY
Title or Position: PHARMACIST
Credential:
Phone: 704-824-4401