Healthcare Provider Details

I. General information

NPI: 1972815157
Provider Name (Legal Business Name): GREGG EADY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2010
Last Update Date: 07/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 W D ST
NORTH WILKESBORO NC
28659-3505
US

IV. Provider business mailing address

502 10TH ST
NORTH WILKESBORO NC
28659-4004
US

V. Phone/Fax

Practice location:
  • Phone: 336-651-2910
  • Fax: 336-651-2907
Mailing address:
  • Phone: 607-341-2210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21187
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: