Provider Demographics
NPI:1275596033
Name:ERWAY, ROY DEXTER
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:DEXTER
Last Name:ERWAY
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 1:4550 KESTER MILL RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1247
Mailing Address - Country:US
Mailing Address - Phone:336-760-9664
Mailing Address - Fax:
Practice Address - Street 1:4550 KESTER MILL RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1247
Practice Address - Country:US
Practice Address - Phone:336-760-9664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047658183500000X
VA0202207454183500000X
NC18182183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202207454OtherSTATE LICENSE NUMBER
NY047658OtherSTATE LICENSE NUMBER
NC18182OtherSTATE LICENSE NUMBER