Healthcare Provider Details

I. General information

NPI: 1700155462
Provider Name (Legal Business Name): ASSOCIATED UROLOGISTS OF NORTH CAROLINA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2011
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 BLUE RIDGE RD STE 405
RALEIGH NC
27607-6476
US

IV. Provider business mailing address

PO BOX 90216
RALEIGH NC
27675-0216
US

V. Phone/Fax

Practice location:
  • Phone: 919-865-4641
  • Fax: 919-865-4644
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number11155
License Number StateNC

VIII. Authorized Official

Name: TONY GURLEY
Title or Position: PHARMACY MANAGER
Credential:
Phone: 919-215-0240