Healthcare Provider Details

I. General information

NPI: 1104026673
Provider Name (Legal Business Name): GUILFORD COUNTY DEPARTMENT OF PUBLIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N EUGENE ST PHARMACY GUILFORD CENTER
GREENSBORO NC
27401-2221
US

IV. Provider business mailing address

201 N EUGENE ST
GREENSBORO NC
27401-2221
US

V. Phone/Fax

Practice location:
  • Phone: 336-641-7777
  • Fax: 336-641-6971
Mailing address:
  • Phone: 336-641-7777
  • Fax: 336-641-6971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number09024
License Number StateNC

VIII. Authorized Official

Name: HARVETTE C JENKINS
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 336-641-7777