Healthcare Provider Details

I. General information

NPI: 1902848500
Provider Name (Legal Business Name): MIDELU INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4822 PLEASANT GARDEN RD
PLEASANT GARDEN NC
27313-8253
US

IV. Provider business mailing address

2593 GREY RABBIT RUN
ASHEBORO NC
27205-8097
US

V. Phone/Fax

Practice location:
  • Phone: 336-674-5611
  • Fax: 336-674-0995
Mailing address:
  • Phone: 336-857-1997
  • Fax: 866-238-8879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number10031
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL GRIFFIN
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 336-963-3317