Provider Demographics
NPI:1386428514
Name:VANDERGRIFT, CALVIN DOUGLAS (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:DOUGLAS
Last Name:VANDERGRIFT
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 MCKNIGHT DR
Mailing Address - Street 2:
Mailing Address - City:KING
Mailing Address - State:NC
Mailing Address - Zip Code:27021-8665
Mailing Address - Country:US
Mailing Address - Phone:336-695-9382
Mailing Address - Fax:
Practice Address - Street 1:650 S MAIN ST
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-9016
Practice Address - Country:US
Practice Address - Phone:336-983-2186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32570183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist