Provider Demographics
NPI:1407149230
Name:MADDOX, BILLY DURAND (RPH)
Entity Type:Individual
Prefix:MR
First Name:BILLY
Middle Name:DURAND
Last Name:MADDOX
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:BILLY
Other - Middle Name:DURAND
Other - Last Name:MADDOX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:202 E RALEIGH ST STE A
Mailing Address - Street 2:
Mailing Address - City:SILER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27344-3559
Mailing Address - Country:US
Mailing Address - Phone:919-663-5541
Mailing Address - Fax:919-663-5577
Practice Address - Street 1:202 E RALEIGH ST STE A
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344-3559
Practice Address - Country:US
Practice Address - Phone:919-663-5541
Practice Address - Fax:919-663-5577
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07216183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist