Provider Demographics
NPI:1902239676
Name:CAUDILL, JAMES ANDREW (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ANDREW
Last Name:CAUDILL
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:PO BOX 887
Mailing Address - Street 2:
Mailing Address - City:GRANITE QUARRY
Mailing Address - State:NC
Mailing Address - Zip Code:28072-0887
Mailing Address - Country:US
Mailing Address - Phone:704-279-2579
Mailing Address - Fax:704-209-3506
Practice Address - Street 1:110 E BANK ST
Practice Address - Street 2:
Practice Address - City:GRANITE QUARRY
Practice Address - State:NC
Practice Address - Zip Code:28072
Practice Address - Country:US
Practice Address - Phone:704-279-2579
Practice Address - Fax:704-209-3506
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12109183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist