Healthcare Provider Details

I. General information

NPI: 1922961721
Provider Name (Legal Business Name): MAKEISHA DANCE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 11/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 CHERRY RUN ROAD
WASHINGTON NC
27889
US

IV. Provider business mailing address

1824 FOX DEN WAY UNIT 6
GREENVILLE NC
27858-2362
US

V. Phone/Fax

Practice location:
  • Phone: 866-946-2425
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number33527
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: