Healthcare Provider Details

I. General information

NPI: 1518552579
Provider Name (Legal Business Name): WILLIAM RANDOLPH MIZE JR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3712 LAWNDALE DR STE G
GREENSBORO NC
27455-3066
US

IV. Provider business mailing address

3712 LAWNDALE DR STE G
GREENSBORO NC
27455-3066
US

V. Phone/Fax

Practice location:
  • Phone: 336-790-7343
  • Fax:
Mailing address:
  • Phone: 336-790-7343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number08455
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: