Provider Demographics
NPI:1831593615
Name:POLHEMUS, JOSEPHINE LOVELACE (RPH)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:LOVELACE
Last Name:POLHEMUS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 FORESTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-7077
Mailing Address - Country:US
Mailing Address - Phone:704-678-7215
Mailing Address - Fax:
Practice Address - Street 1:12TH AVENUE NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601
Practice Address - Country:US
Practice Address - Phone:401-665-9765
Practice Address - Fax:401-652-0281
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9431183500000X
SC7349183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist