Provider Demographics
NPI:1699775221
Name:AYSCUE, DWIGHT M (RPH)
Entity type:Individual
Prefix:
First Name:DWIGHT
Middle Name:M
Last Name:AYSCUE
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 1:804 HILLSBORO ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-3131
Mailing Address - Country:US
Mailing Address - Phone:919-693-6272
Mailing Address - Fax:
Practice Address - Street 1:202 E INDUSTRY DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-4002
Practice Address - Country:US
Practice Address - Phone:919-603-0101
Practice Address - Fax:919-603-8053
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6175183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist