Provider Demographics
NPI:1972510071
Name:YADKIN VALLEY HEALTH CARE LLC
Entity Type:Organization
Organization Name:YADKIN VALLEY HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DELBERT
Authorized Official - Middle Name:MARVIN
Authorized Official - Last Name:CRANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:336-859-0272
Mailing Address - Street 1:17955 NC HWY 109 S
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27239
Mailing Address - Country:US
Mailing Address - Phone:336-859-0272
Mailing Address - Fax:336-859-2192
Practice Address - Street 1:17955 NC HWY 109 S
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:NC
Practice Address - Zip Code:27239
Practice Address - Country:US
Practice Address - Phone:336-859-0272
Practice Address - Fax:336-859-2192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC084193336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0295830Medicaid