Healthcare Provider Details

I. General information

NPI: 1689185068
Provider Name (Legal Business Name): CASSIE LYNN KUPPELWEISER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASSIE LYNN STEWART

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 10/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E WENDOVER AVE
GREENSBORO NC
27401-1230
US

IV. Provider business mailing address

301 E WENDOVER AVE
GREENSBORO NC
27401-1230
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-7840
  • Fax: 336-832-3249
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number25196
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: