Healthcare Provider Details

I. General information

NPI: 1386637981
Provider Name (Legal Business Name): ELLIOTT MICHAEL SOGOL R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8210 RENAISSANCE PARKWAY
DURHAM NC
27713
US

IV. Provider business mailing address

3828 SWEETEN CREEK RD
CHAPEL HILL NC
27514-9706
US

V. Phone/Fax

Practice location:
  • Phone: 919-425-0001
  • Fax:
Mailing address:
  • Phone: 919-408-8208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11663
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9814
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: