=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437282738
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PERRY P DIAMADUROS RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4220 N TRYON ST
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28206-2069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-596-8233
-----------------------------------------------------
Fax | 704-921-1180
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1123 CAMEO CT
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28270-1001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-998-6216
-----------------------------------------------------
Fax | 704-998-6216
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 6025
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------