=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780218347
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLIEDRX PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2020
-----------------------------------------------------
Last Update Date | 09/12/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 505 SAMARITANS RIDGE CT STE 101
-----------------------------------------------------
City | ELKIN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28621-2457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-258-2255
-----------------------------------------------------
Fax | 336-530-4207
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 505 SAMARITANS RIDGE CT STE 101
-----------------------------------------------------
City | ELKIN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28621-2457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-258-2255
-----------------------------------------------------
Fax | 336-530-4207
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY MANAGER/OWNER
-----------------------------------------------------
Name | DR. KELECHI COURAGE ONYIRIUKA
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 336-258-2255
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------