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General NPI Number Information
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NPI Number | 1114234903
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Entity Type | Organization
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Legal Business Name | NORTH CAROLINA A T STATE UNIVERSITY
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Dates
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Enumeration Date | 09/01/2010
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Last Update Date | 05/27/2016
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Provider Practice Location Address
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Address Line | 112. N. BENBOW ROAD
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City | GREENSBORO
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State | NC
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Zip | 27411-0001
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Country | US
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Telephone | 336-285-2908
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Fax | 336-256-2903
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Provider Business Mailing Address
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Address Line | 112. N. BENBOW ROAD
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City | GREENSBORO
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State | NC
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Zip | 27411-0001
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Country | US
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Telephone | 336-285-2908
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Fax | 336-256-2903
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | MRS. BANNIE H HATCH
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Credential | RPH
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Telephone | 336-285-2908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 04312
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License Number State | NC
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