Provider Demographics
NPI:1083942361
Name:HATHCOCK, JAMES ALDEN JR (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALDEN
Last Name:HATHCOCK
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 N BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-2301
Mailing Address - Country:US
Mailing Address - Phone:336-526-0011
Mailing Address - Fax:336-526-6005
Practice Address - Street 1:1209 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2301
Practice Address - Country:US
Practice Address - Phone:336-526-0011
Practice Address - Fax:336-526-6005
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC04523183500000X
VA0202006239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist