Provider Demographics
NPI:1053672717
Name:FEUDALE, PAGE HARDISON (RPH)
Entity Type:Individual
Prefix:
First Name:PAGE
Middle Name:HARDISON
Last Name:FEUDALE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E ELM ST STE A
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-3055
Mailing Address - Country:US
Mailing Address - Phone:336-226-4401
Mailing Address - Fax:336-228-9996
Practice Address - Street 1:210 E ELM ST STE A
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-3055
Practice Address - Country:US
Practice Address - Phone:336-226-4401
Practice Address - Fax:336-228-9996
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8092183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8092OtherNORTH CAROLINA BOARD OF PHARMACY LISCENSE