Healthcare Provider Details

I. General information

NPI: 1588962104
Provider Name (Legal Business Name): PATRICK JOHN OGRIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2011
Last Update Date: 03/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 N COLLEGE RD
WILMINGTON NC
28405-8814
US

IV. Provider business mailing address

2401 N COLLEGE RD
WILMINGTON NC
28405-8814
US

V. Phone/Fax

Practice location:
  • Phone: 910-395-2214
  • Fax:
Mailing address:
  • Phone: 910-395-2214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13112
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: