=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447796495
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAULETTE DEAL RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2017
-----------------------------------------------------
Last Update Date | 01/15/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1116 CROSSROADS DR
-----------------------------------------------------
City | STATESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28625-8277
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-871-9824
-----------------------------------------------------
Fax | 704-872-6462
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 242 MONTE VISTA RD
-----------------------------------------------------
City | STATESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28625-2327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-500-8811
-----------------------------------------------------
Fax | 704-872-6462
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 7931
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------