Healthcare Provider Details

I. General information

NPI: 1932549169
Provider Name (Legal Business Name): NICHOLAS L REID PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 GROOMETOWN RD
GREENSBORO NC
27407-6525
US

IV. Provider business mailing address

3611 GROOMETOWN RD
GREENSBORO NC
27407-6525
US

V. Phone/Fax

Practice location:
  • Phone: 336-856-7437
  • Fax: 336-294-2440
Mailing address:
  • Phone: 336-856-7437
  • Fax: 336-294-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23343
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: