Healthcare Provider Details

I. General information

NPI: 1245446905
Provider Name (Legal Business Name): PIEDMONT HEM ONC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 BETHESDA CT
WINSTON SALEM NC
27103-3019
US

IV. Provider business mailing address

PO BOX 1243
CHARLOTTE NC
28201-1243
US

V. Phone/Fax

Practice location:
  • Phone: 336-277-8864
  • Fax: 336-277-8983
Mailing address:
  • Phone: 919-425-6398
  • Fax: 919-425-6959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number10993
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NICK CHRYSSON
Title or Position: PRESIDENT
Credential:
Phone: 336-277-8800