Provider Demographics
NPI:1578861969
Name:ADDISON, JAMES HARLEY III (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:HARLEY
Last Name:ADDISON
Suffix:III
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2206 W FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-1341
Mailing Address - Country:US
Mailing Address - Phone:704-864-8336
Mailing Address - Fax:704-864-9954
Practice Address - Street 1:2206 W FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-1341
Practice Address - Country:US
Practice Address - Phone:704-864-8336
Practice Address - Fax:704-864-9954
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC05370183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist