Provider Demographics
NPI:1790097509
Name:JEGEDE, ELIZABETH OLAIDE (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:OLAIDE
Last Name:JEGEDE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6147 CHAMBERLAIN PL
Mailing Address - Street 2:APT 201
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-7148
Mailing Address - Country:US
Mailing Address - Phone:336-766-0066
Mailing Address - Fax:336-766-0066
Practice Address - Street 1:6475 OLD HIGHWAY 52
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-731-3033
Practice Address - Fax:336-731-0273
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20871183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist