Provider Demographics
NPI:1831315720
Name:ACHESON, GERALD PHILIP (RPH)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:PHILIP
Last Name:ACHESON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 DUNLEITH WAY
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-3214
Mailing Address - Country:US
Mailing Address - Phone:336-638-4141
Mailing Address - Fax:
Practice Address - Street 1:4701 W MARKET ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1233
Practice Address - Country:US
Practice Address - Phone:336-854-7827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16986183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist