Provider Demographics
NPI:1770868317
Name:UNDERWOOD, MILDRED ANN
Entity Type:Individual
Prefix:MISS
First Name:MILDRED
Middle Name:ANN
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:MILDRED
Other - Middle Name:ANN
Other - Last Name:UNDERWOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:6013 HIGH VIEW RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8331
Mailing Address - Country:US
Mailing Address - Phone:336-668-3849
Mailing Address - Fax:336-768-4972
Practice Address - Street 1:250 CHARLOIS BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1508
Practice Address - Country:US
Practice Address - Phone:336-718-1417
Practice Address - Fax:336-768-4972
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist