Provider Demographics
NPI:1649515362
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:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SONY
Authorized Official - Middle Name:A
Authorized Official - Last Name:OBUSEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-971-9880
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:704-971-9880
Mailing Address - Fax:704-971-9881
Practice Address - Street 1:9040 NATIONS FORD RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-5716
Practice Address - Country:US
Practice Address - Phone:704-971-9880
Practice Address - Fax:704-971-9881
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIEDMONT PHARMACY SOLUTIONS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104883336C0002X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0602494Medicaid
6470150001Medicare NSC