Provider Demographics
NPI:1124170725
Name:UNIVERSITY OF NORTH CAROLINA AT GREENSBORO
Entity type:Organization
Organization Name:UNIVERSITY OF NORTH CAROLINA AT GREENSBORO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:MOSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:336-334-3348
Mailing Address - Street 1:107 GRAY DRIVE
Mailing Address - Street 2:ROOM 147A
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27402-0001
Mailing Address - Country:US
Mailing Address - Phone:336-334-3348
Mailing Address - Fax:336-334-5343
Practice Address - Street 1:107 GRAY DRIVE
Practice Address - Street 2:ROOM 147A
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27402-0001
Practice Address - Country:US
Practice Address - Phone:336-334-3348
Practice Address - Fax:336-334-5343
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF NORTH CAROLINA AT GREENSBORO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-17
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30313336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3422855OtherNCPDP NUMBER