Healthcare Provider Details

I. General information

NPI: 1982004289
Provider Name (Legal Business Name): THE MOSES H. CONE MEMORIAL HOSPITAL OPERATING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2014
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E WENDOVER AVE
GREENSBORO NC
27401-1205
US

IV. Provider business mailing address

201 E WENDOVER AVE
GREENSBORO NC
27401-1205
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-3630
  • Fax: 336-832-3632
Mailing address:
  • Phone: 336-832-3630
  • Fax: 336-832-3632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number12080
License Number StateNC

VIII. Authorized Official

Name: COURTNEY BLACKWELL ISOM
Title or Position: PHARMACY MANAGER
Credential: PHARMD
Phone: 336-832-3631