Provider Demographics
NPI:1972881589
Name:DOROUGH, JAMES GRANT (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:GRANT
Last Name:DOROUGH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7892 IDLEWILD RD
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-8675
Mailing Address - Country:US
Mailing Address - Phone:704-821-6885
Mailing Address - Fax:704-882-0371
Practice Address - Street 1:7892 IDLEWILD RD
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-8675
Practice Address - Country:US
Practice Address - Phone:704-821-6885
Practice Address - Fax:704-882-0371
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-30
Last Update Date:2011-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC112671835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy