Provider Demographics
NPI:1053480681
Name:MEDLIN, DWIGHT ANTHONY (PHARMACIST RPH)
Entity Type:Individual
Prefix:MR
First Name:DWIGHT
Middle Name:ANTHONY
Last Name:MEDLIN
Suffix:
Gender:M
Credentials:PHARMACIST RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 LEAS LANE
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443
Mailing Address - Country:US
Mailing Address - Phone:910-270-3512
Mailing Address - Fax:
Practice Address - Street 1:714 NEW BRIDGE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540
Practice Address - Country:US
Practice Address - Phone:910-347-5185
Practice Address - Fax:910-347-9298
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13318183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist