Provider Demographics
NPI:1316172190
Name:BROGDEN, HARRY LEE JR
Entity type:Individual
Prefix:MR
First Name:HARRY
Middle Name:LEE
Last Name:BROGDEN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4446 US HIGHWAY 220 N STE C
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27358-9415
Mailing Address - Country:US
Mailing Address - Phone:336-644-7058
Mailing Address - Fax:336-644-7297
Practice Address - Street 1:4446 US HIGHWAY 220 N STE C
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:NC
Practice Address - Zip Code:27358-9415
Practice Address - Country:US
Practice Address - Phone:336-644-7058
Practice Address - Fax:336-644-7297
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10438183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0418181Medicaid
NC5485980001Medicare PIN