Healthcare Provider Details

I. General information

NPI: 1902239676
Provider Name (Legal Business Name): JAMES ANDREW CAUDILL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E BANK ST
GRANITE QUARRY NC
28072
US

IV. Provider business mailing address

PO BOX 887
GRANITE QUARRY NC
28072-0887
US

V. Phone/Fax

Practice location:
  • Phone: 704-279-2579
  • Fax: 704-209-3506
Mailing address:
  • Phone: 704-279-2579
  • Fax: 704-209-3506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12109
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: