Healthcare Provider Details

I. General information

NPI: 1740759778
Provider Name (Legal Business Name): ROSE-KARYL ESUNG ALOBWEDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 N HERRITAGE ST
KINSTON NC
28501-2223
US

IV. Provider business mailing address

128 BILLSDALE RD
IRMO SC
29063-2168
US

V. Phone/Fax

Practice location:
  • Phone: 252-522-4902
  • Fax:
Mailing address:
  • Phone: 980-365-3826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: