Provider Demographics
NPI:1225070675
Name:STOKES REYNOLDS MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:STOKES REYNOLDS MEMORIAL HOSPITAL INC
Other - Org Name:STOKES REYNOLDS MEM HOSP PHCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:336-593-5329
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:NC
Mailing Address - Zip Code:27016-0010
Mailing Address - Country:US
Mailing Address - Phone:336-593-5329
Mailing Address - Fax:336-593-5327
Practice Address - Street 1:1570 NC 8&89 HWY NORTH
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:NC
Practice Address - Zip Code:27016-0010
Practice Address - Country:US
Practice Address - Phone:336-593-5329
Practice Address - Fax:336-593-5327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336I0012X
NC054683336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3405265OtherNCPDP PROVIDER IDENTIFICATION NUMBER