Provider Demographics
NPI:1356469886
Name:TOLLEY, MIKE DEAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:MIKE
Middle Name:DEAN
Last Name:TOLLEY
Suffix:
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 1:2294 US HIGHWAY 70
Mailing Address - Street 2:
Mailing Address - City:SWANNANOA
Mailing Address - State:NC
Mailing Address - Zip Code:28778
Mailing Address - Country:US
Mailing Address - Phone:828-686-3804
Mailing Address - Fax:828-686-3839
Practice Address - Street 1:2294 US HIGHWAY 70
Practice Address - Street 2:PSA CLINIC PHARMACY
Practice Address - City:SWANNANOA
Practice Address - State:NC
Practice Address - Zip Code:28778
Practice Address - Country:US
Practice Address - Phone:828-686-3804
Practice Address - Fax:828-686-3839
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC6070183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6070OtherPHARMACY BOARD