Provider Demographics
NPI:1467745802
Name:ADDY, ALFRED (RPH)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:
Last Name:ADDY
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 1:2704 CLONNEL CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3796
Mailing Address - Country:US
Mailing Address - Phone:919-877-0819
Mailing Address - Fax:
Practice Address - Street 1:2704 CLONNEL CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3796
Practice Address - Country:US
Practice Address - Phone:919-877-0819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist