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General NPI Number Information
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NPI Number | 1548679749
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Entity Type | Organization
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Legal Business Name | TRIAD ADULT AND PEDIATRIC MED-GCH WENDOVER PHARMACY
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Dates
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Enumeration Date | 08/13/2014
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Last Update Date | 09/30/2014
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Provider Practice Location Address
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Address Line | 1046 E WENDOVER AVE
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City | GREENSBORO
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State | NC
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Zip | 27405-6712
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Country | US
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Telephone | 336-355-9908
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Fax |
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Provider Business Mailing Address
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Address Line | 1046 E WENDOVER AVE
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City | GREENSBORO
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State | NC
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Zip | 27405-6712
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Country | US
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Telephone | 336-355-9908
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Fax |
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Authorized Official
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Title or Position | DEPARTMENT ADMINISTRATIVE ASSISTANT
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Name | CHRIS LAMBETH
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Credential | CPHT
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Telephone | 336-355-9908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 11385
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License Number State | NC
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