Provider Demographics
NPI:1700903416
Name:MIDEL INCORPORATED
Entity Type:Organization
Organization Name:MIDEL INCORPORATED
Other - Org Name:STANDARD DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:336-495-5100
Mailing Address - Street 1:2593 GREY RABBIT RUN
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27205-8097
Mailing Address - Country:US
Mailing Address - Phone:336-857-1997
Mailing Address - Fax:866-238-8879
Practice Address - Street 1:522 ALLEN ST
Practice Address - Street 2:STE 102
Practice Address - City:TROY
Practice Address - State:NC
Practice Address - Zip Code:27371-2861
Practice Address - Country:US
Practice Address - Phone:910-571-5610
Practice Address - Fax:910-571-5616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2067506OtherPK
NC0625195Medicaid