Provider Demographics
NPI:1326364472
Name:STOKESDALE FAMILY PHARMACY
Entity Type:Organization
Organization Name:STOKESDALE FAMILY PHARMACY
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:
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:336-644-7291
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:336-644-7291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10378333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1174859722OtherNPI