Provider Demographics
NPI:1255654000
Name:CHINERY, CLIVE
Entity Type:Individual
Prefix:MR
First Name:CLIVE
Middle Name:
Last Name:CHINERY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10020 PINEVILLE MATTHEWS RD
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28134-7552
Mailing Address - Country:US
Mailing Address - Phone:704-889-2029
Mailing Address - Fax:
Practice Address - Street 1:10020 PINEVILLE MATTHEWS RD
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134-7552
Practice Address - Country:US
Practice Address - Phone:704-889-2029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0608561Medicaid