Provider Demographics
NPI:1881624005
Name:SKINNER, ROY LEE (RPH)
Entity type:Individual
Prefix:MR
First Name:ROY
Middle Name:LEE
Last Name:SKINNER
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 1:5805 DEPARTURE DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616
Mailing Address - Country:US
Mailing Address - Phone:919-850-9496
Mailing Address - Fax:
Practice Address - Street 1:5805 DEPARTURE DR
Practice Address - Street 2:SUITE E
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616
Practice Address - Country:US
Practice Address - Phone:919-850-9496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist