Provider Demographics
NPI:1437282738
Name:DIAMADUROS, PERRY P (RPH)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:P
Last Name:DIAMADUROS
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 1:1123 CAMEO CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-1001
Mailing Address - Country:US
Mailing Address - Phone:704-998-6216
Mailing Address - Fax:704-998-6216
Practice Address - Street 1:4220 N TRYON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-2069
Practice Address - Country:US
Practice Address - Phone:704-596-8233
Practice Address - Fax:704-921-1180
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6025183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3400316OtherNCPDP