Provider Demographics
NPI:1609282912
Name:STAFFORD, PHILLIP G (PHARMD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:G
Last Name:STAFFORD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 WESTCHESTER DR
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7008
Mailing Address - Country:US
Mailing Address - Phone:336-802-2536
Mailing Address - Fax:336-802-2534
Practice Address - Street 1:1208 EASTCHESTER DR
Practice Address - Street 2:SUITE 107
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-3170
Practice Address - Country:US
Practice Address - Phone:336-802-2588
Practice Address - Fax:336-802-2340
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07844183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist