Provider Demographics
NPI:1780218347
Name:ALLIEDRX PHARMACY
Entity Type:Organization
Organization Name:ALLIEDRX PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELECHI
Authorized Official - Middle Name:COURAGE
Authorized Official - Last Name:ONYIRIUKA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:336-258-2255
Mailing Address - Street 1:505 SAMARITANS RIDGE CT STE 101
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-2457
Mailing Address - Country:US
Mailing Address - Phone:336-258-2255
Mailing Address - Fax:336-530-4207
Practice Address - Street 1:505 SAMARITANS RIDGE CT STE 101
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2457
Practice Address - Country:US
Practice Address - Phone:336-258-2255
Practice Address - Fax:336-530-4207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-22
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy