Healthcare Provider Details

I. General information

NPI: 1013486455
Provider Name (Legal Business Name): GREGORY BODENHEIMER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 N MAIN ST UNIT 101
HIGH POINT NC
27262-2167
US

IV. Provider business mailing address

2005 N MAIN ST UNIT 101
HIGH POINT NC
27262-2167
US

V. Phone/Fax

Practice location:
  • Phone: 336-804-6001
  • Fax:
Mailing address:
  • Phone: 336-804-6001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28111
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: