Provider Demographics
NPI:1538496179
Name:PIEDMONT DRUG & HOME DELIVERY, L.L.C.
Entity Type:Organization
Organization Name:PIEDMONT DRUG & HOME DELIVERY, L.L.C.
Other - Org Name:PIEDMONT DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:336-856-7577
Mailing Address - Street 1:4620 WOODY MILL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-8779
Mailing Address - Country:US
Mailing Address - Phone:336-856-7577
Mailing Address - Fax:336-856-7511
Practice Address - Street 1:4620 WOODY MILL RD
Practice Address - Street 2:SUITE B
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-8779
Practice Address - Country:US
Practice Address - Phone:336-856-7577
Practice Address - Fax:336-856-7511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0418564Medicaid
NC6365530001Medicare NSC