Provider Demographics
NPI:1194292003
Name:ALCIDE, CONNOR BRADLEY (PHARMD)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:BRADLEY
Last Name:ALCIDE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 TREYBROOKE CIR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-9137
Mailing Address - Country:US
Mailing Address - Phone:704-477-4563
Mailing Address - Fax:
Practice Address - Street 1:140 NC 102 W
Practice Address - Street 2:
Practice Address - City:AYDEN
Practice Address - State:NC
Practice Address - Zip Code:28513-8792
Practice Address - Country:US
Practice Address - Phone:252-746-3026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS58473183500000X
NC28310183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist