Provider Demographics
NPI:1083900849
Name:BARNES, DENISE GRAY
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:GRAY
Last Name:BARNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYNDA
Other - Middle Name:DENISE
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2104 PENDRAGON CT
Mailing Address - Street 2:
Mailing Address - City:PFAFFTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27040-9211
Mailing Address - Country:US
Mailing Address - Phone:336-946-2602
Mailing Address - Fax:
Practice Address - Street 1:5471 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-1374
Practice Address - Country:US
Practice Address - Phone:336-744-2321
Practice Address - Fax:336-744-2329
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10076183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist