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General NPI Number Information
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NPI Number | 1831883081
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Entity Type | Organization
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Legal Business Name | THE SHALOM PROJECT, INC
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Dates
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Enumeration Date | 06/08/2023
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Last Update Date | 06/13/2023
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Provider Practice Location Address
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Address Line | 3185 MAPLEWOOD AVE
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City | WINSTON SALEM
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State | NC
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Zip | 27103-3903
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Country | US
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Telephone | 919-451-0097
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Fax |
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Provider Business Mailing Address
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Address Line | 639 S GREEN ST
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City | WINSTON SALEM
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State | NC
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Zip | 27101-5109
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Country | US
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Telephone | 919-451-0097
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Fax |
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Authorized Official
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Title or Position | PHARMACIST MANAGER
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Name | DR. TRACY LOGGIN YEHLE
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Credential | PHARMD
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Telephone | 919-451-0097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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