Healthcare Provider Details

I. General information

NPI: 1043350804
Provider Name (Legal Business Name): COMMUNITY PHARMACY OF GRANITE FALLS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 FALLS AVE
GRANITE FALLS NC
28630
US

IV. Provider business mailing address

21 FALLS AVE
GRANITE FALLS NC
28630
US

V. Phone/Fax

Practice location:
  • Phone: 828-396-2144
  • Fax: 828-396-9561
Mailing address:
  • Phone: 828-396-2144
  • Fax: 828-396-9561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13303
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number02793
License Number StateNC

VIII. Authorized Official

Name: BRYAN HUFFSTETLER
Title or Position: OWNER & PIC
Credential: PHARMD
Phone: 828-396-2144