Healthcare Provider Details

I. General information

NPI: 1609282912
Provider Name (Legal Business Name): PHILLIP G STAFFORD PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 07/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 EASTCHESTER DR SUITE 107
HIGH POINT NC
27265-3170
US

IV. Provider business mailing address

1701 WESTCHESTER DR SUITE 850
HIGH POINT NC
27262-7008
US

V. Phone/Fax

Practice location:
  • Phone: 336-802-2588
  • Fax: 336-802-2340
Mailing address:
  • Phone: 336-802-2536
  • Fax: 336-802-2534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number07844
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: