Provider Demographics
NPI:1396067567
Name:PIEDMONT PHARMACY SOLUTIONS INC
Entity type:Organization
Organization Name:PIEDMONT PHARMACY SOLUTIONS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MGR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SONY
Authorized Official - Middle Name:
Authorized Official - Last Name:OBUSEH
Authorized Official - Suffix:
Authorized Official - Credentials:BPHARM
Authorized Official - Phone:704-243-1202
Mailing Address - Street 1:PO BOX 78317
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28271-7030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1816 E ARBORS DR STE 410
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-2666
Practice Address - Country:US
Practice Address - Phone:704-971-9880
Practice Address - Fax:704-971-9881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-15
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 3336L0003X, 3336C0003X, 332B00000X
NC10488333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3418515OtherNCPDP PROVIDER IDENTIFICATION NUMBER
3418515OtherNCPDP PROVIDER IDENTIFICATION NUMBER