Provider Demographics
NPI:1174859722
Name:STOKESDALE FAMILY PHARMACY INC.
Entity Type:Organization
Organization Name:STOKESDALE FAMILY PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH MBA
Authorized Official - Phone:336-595-6979
Mailing Address - Street 1:8500 US HIGHWAY 158
Mailing Address - Street 2:PO BOX 63
Mailing Address - City:STOKESDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27357-9248
Mailing Address - Country:US
Mailing Address - Phone:336-644-7288
Mailing Address - Fax:336-644-7390
Practice Address - Street 1:8500 US HIGHWAY 158
Practice Address - Street 2:
Practice Address - City:STOKESDALE
Practice Address - State:NC
Practice Address - Zip Code:27357-9248
Practice Address - Country:US
Practice Address - Phone:336-644-7288
Practice Address - Fax:336-664-7290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10525333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0418556Medicaid