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General NPI Number Information
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NPI Number | 1679850879
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Entity Type | Organization
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Legal Business Name | TODDS NORTHSIDE PROFESSIONAL PHARMACY,INC.
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Dates
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Enumeration Date | 11/16/2011
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Last Update Date | 11/16/2011
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Provider Practice Location Address
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Address Line | 1141 N ROAD ST
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City | ELIZABETH CITY
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State | NC
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Zip | 27909-3354
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Country | US
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Telephone | 252-331-1333
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Fax | 252-331-1911
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Provider Business Mailing Address
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Address Line | 1141 N ROAD ST
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City | ELIZABETH CITY
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State | NC
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Zip | 27909-3354
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Country | US
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Telephone | 252-331-1333
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Fax | 252-331-1911
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | WILLIAM WINFRED OWENS
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Credential |
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Telephone | 252-331-1333
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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 | 05351
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License Number State | NC
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