Provider Demographics
NPI:1235967415
Name:MEDLIN, RIVER
Entity type:Individual
Prefix:
First Name:RIVER
Middle Name:
Last Name:MEDLIN
Suffix:
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:PO BOX 1463
Mailing Address - Street 2:
Mailing Address - City:BUIES CREEK
Mailing Address - State:NC
Mailing Address - Zip Code:27506-1463
Mailing Address - Country:US
Mailing Address - Phone:704-701-2377
Mailing Address - Fax:
Practice Address - Street 1:101 ROBESON ST STE 107
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5520
Practice Address - Country:US
Practice Address - Phone:910-615-1800
Practice Address - Fax:910-321-6292
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist