MEDICARE: PAGE HARDISON FEUDALE RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	8092	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8092	OTHER	NC	NORTH CAROLINA BOARD OF PHARMACY LISCENSE

General Provider Information

NPI Number	:	1053672717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAGE HARDISON FEUDALE RPH

Provider Business Mailing Address
First Line	:	210 E ELM ST STE A
Second Line	:
City	:	GRAHAM
State	:	NC
Zip	:	27253-3055
Country	:	US
Telephone Number	:	336-226-4401
Fax Number	:	336-228-9996

Provider Business Practice Location Address
First Line	:	210 E ELM ST STE A
Second Line	:
City	:	GRAHAM
State	:	NC
Zip	:	27253-3055
Country	:	US
Telephone Number	:	336-226-4401
Fax Number	:	336-228-9996

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2012
Last Update Date	:	05/30/2012

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