Healthcare Provider Details

I. General information

NPI: 1659647303
Provider Name (Legal Business Name): JOEL DWAINE PUTNAM PHARMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3282 SAND WEDGE CT
DENVER NC
28037-8283
US

IV. Provider business mailing address

3282 SAND WEDGE CT
DENVER NC
28037-8283
US

V. Phone/Fax

Practice location:
  • Phone: 704-249-4925
  • Fax:
Mailing address:
  • Phone: 704-249-4925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15465
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: