Healthcare Provider Details

I. General information

NPI: 1265799894
Provider Name (Legal Business Name): MIDTOWN PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 CENTER CREST DR STE A
WHITSETT NC
27377-8002
US

IV. Provider business mailing address

941 CENTER CREST DR STE A
WHITSETT NC
27377-8002
US

V. Phone/Fax

Practice location:
  • Phone: 336-446-0099
  • Fax: 336-446-0094
Mailing address:
  • Phone: 336-446-0099
  • Fax: 336-446-0094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number08335
License Number StateNC

VIII. Authorized Official

Name: DR. ROBERT GRANDISON COCKMAN
Title or Position: OWNER
Credential: PHARMD
Phone: 336-446-0099