Healthcare Provider Details

I. General information

NPI: 1477841658
Provider Name (Legal Business Name): PIONEER HEALTH SERVICES OF STOKES COUNTY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 12/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 NC 8&89 HWY NORTH
DANBURY NC
27016-0010
US

IV. Provider business mailing address

1570 NC 8&89 HWY NORTH
DANBURY NC
27016-0010
US

V. Phone/Fax

Practice location:
  • Phone: 336-593-5329
  • Fax: 336-593-5327
Mailing address:
  • Phone: 336-593-5329
  • Fax: 336-593-5327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number11080
License Number StateNC

VIII. Authorized Official

Name: JOSEPH MCNULTY, III
Title or Position: CEO
Credential:
Phone: 601-849-6440