Provider Demographics
NPI:1497002802
Name:PATRICK, JAMES (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:PATRICK
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:PATRICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:1156 E CASWELL ST
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-2376
Mailing Address - Country:US
Mailing Address - Phone:704-694-2153
Mailing Address - Fax:704-694-5126
Practice Address - Street 1:1156 E CASWELL ST
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-2376
Practice Address - Country:US
Practice Address - Phone:704-694-2153
Practice Address - Fax:704-694-5126
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11104183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist