Provider Demographics
NPI:1558492439
Name:PIEDMONT HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:PIEDMONT HEALTH SERVICES, INC.
Other - Org Name:PROSPECT HILL CHC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:F
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-933-8494
Mailing Address - Street 1:322 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PROSPECT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27314
Mailing Address - Country:US
Mailing Address - Phone:336-562-5972
Mailing Address - Fax:336-562-3223
Practice Address - Street 1:322 MAIN STREET
Practice Address - Street 2:
Practice Address - City:PROSPECT HILL
Practice Address - State:NC
Practice Address - Zip Code:27314
Practice Address - Country:US
Practice Address - Phone:336-562-5972
Practice Address - Fax:336-562-3223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC029973336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC-AP5808641OtherN.C. CONTROLLED SUBS. REG
NC34-4514BMedicaid
NC344514BMedicaid
NC344514BMedicaid
NCAP5808641OtherDEA REGISTRATION