Provider Demographics
NPI:1538449764
Name:MCLEMORE, EDGBERT RAY JR (RPH)
Entity type:Individual
Prefix:
First Name:EDGBERT
Middle Name:RAY
Last Name:MCLEMORE
Suffix:JR
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 1:201 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-2141
Mailing Address - Country:US
Mailing Address - Phone:910-292-2376
Mailing Address - Fax:
Practice Address - Street 1:1103 N BREAZEALE AVE
Practice Address - Street 2:
Practice Address - City:MT OLIVE
Practice Address - State:NC
Practice Address - Zip Code:28365
Practice Address - Country:US
Practice Address - Phone:919-658-8510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist