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General NPI Number Information
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NPI Number | 1124396593
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Entity Type | Organization
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Legal Business Name | PROHEALTH PHARMACY INC
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Dates
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Enumeration Date | 12/13/2011
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Last Update Date | 01/12/2015
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Provider Practice Location Address
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Address Line | 280 N POINTE BLVD
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City | MOUNT AIRY
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State | NC
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Zip | 27030-2267
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Country | US
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Telephone | 336-719-6010
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Fax | 336-719-6011
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Provider Business Mailing Address
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Address Line | 280 N POINTE BLVD
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City | MOUNT AIRY
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State | NC
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Zip | 27030-2267
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Country | US
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Telephone | 336-719-6010
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Fax | 336-719-6011
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Authorized Official
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Title or Position | OWNER
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Name | DONALD GARDNER
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Credential | PHARMD
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Telephone | 336-719-6006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | 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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 11144
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License Number State | NC
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