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General NPI Number Information
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NPI Number | 1598087660
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Entity Type | Organization
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Legal Business Name | UNIVERSAL DISTRIBUTORS
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Dates
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Enumeration Date | 02/17/2010
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Last Update Date | 02/17/2010
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Provider Practice Location Address
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Address Line | 1101 TYVOLA RD SUITE 321
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City | CHARLOTTE
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State | NC
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Zip | 28217-3515
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Country | US
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Telephone | 704-277-3135
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Fax | 800-851-3009
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Provider Business Mailing Address
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Address Line | 1101 TYVOLA RD SUITE 321
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City | CHARLOTTE
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State | NC
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Zip | 28217-3515
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Country | US
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Telephone | 704-277-3135
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Fax | 800-851-3009
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. JAMES GILLESPIE JR.
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Credential |
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Telephone | 704-723-9662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number |
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License Number State |
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