Healthcare Provider Details

I. General information

NPI: 1073827481
Provider Name (Legal Business Name): GROWING CHILD OFFICE MEDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11130 CAPITAL BLVD
WAKE FOREST NC
27587-4513
US

IV. Provider business mailing address

PO BOX 90804
RALEIGH NC
27675-0804
US

V. Phone/Fax

Practice location:
  • Phone: 919-488-4094
  • Fax: 919-488-4096
Mailing address:
  • Phone: 919-215-0240
  • Fax: 919-865-9998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number10569
License Number StateNC

VIII. Authorized Official

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