Provider Demographics
NPI:1841882552
Name:KOONCE, STERLING GRADY (RPH)
Entity type:Individual
Prefix:
First Name:STERLING
Middle Name:GRADY
Last Name:KOONCE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TABOR CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28463-1904
Mailing Address - Country:US
Mailing Address - Phone:910-653-6805
Mailing Address - Fax:910-653-5172
Practice Address - Street 1:220 S MAIN ST
Practice Address - Street 2:
Practice Address - City:TABOR CITY
Practice Address - State:NC
Practice Address - Zip Code:28463-1904
Practice Address - Country:US
Practice Address - Phone:910-653-6805
Practice Address - Fax:910-653-5172
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9707183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist