Healthcare Provider Details

I. General information

NPI: 1770620205
Provider Name (Legal Business Name): FOOTHILLS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2924 N NC HIGHWAY 16
MILLERS CREEK NC
28651-8884
US

IV. Provider business mailing address

PO BOX 39
MILLERS CREEK NC
28651-0039
US

V. Phone/Fax

Practice location:
  • Phone: 336-838-3145
  • Fax: 336-838-0950
Mailing address:
  • Phone: 336-838-3145
  • Fax: 336-838-0950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number04267
License Number StateNC

VIII. Authorized Official

Name: MR. JAMES HERMAN OSBORNE JR.
Title or Position: OWNER
Credential: PHARMACIST
Phone: 336-838-3145