Provider Demographics
NPI:1477683704
Name:AVERY, DARRELL W (RPH)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:W
Last Name:AVERY
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 1:4903 CARMEL LN N
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-9004
Mailing Address - Country:US
Mailing Address - Phone:252-243-9058
Mailing Address - Fax:
Practice Address - Street 1:8282 SOUTH NC 58 HWY
Practice Address - Street 2:
Practice Address - City:ELM CITY
Practice Address - State:NC
Practice Address - Zip Code:27822
Practice Address - Country:US
Practice Address - Phone:252-443-7744
Practice Address - Fax:252-443-7611
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist