Provider Demographics
NPI:1801481247
Name:ALTIZER, DEREK KEITH (PHARM D)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:KEITH
Last Name:ALTIZER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15 GLENN BRIDGE RD STE A
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-8481
Mailing Address - Country:US
Mailing Address - Phone:828-585-2034
Mailing Address - Fax:855-782-5622
Practice Address - Street 1:15 GLENN BRIDGE RD STE A
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-8481
Practice Address - Country:US
Practice Address - Phone:828-585-2034
Practice Address - Fax:855-782-5622
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40092183500000X
SC35888183500000X
WVRP0007830183500000X
NC19901183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist