Provider Demographics
NPI:1578231643
Name:LEDFORD, MACY
Entity type:Individual
Prefix:
First Name:MACY
Middle Name:
Last Name:LEDFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 LARKHILL CT
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-8661
Mailing Address - Country:US
Mailing Address - Phone:336-534-6436
Mailing Address - Fax:
Practice Address - Street 1:4700 PIEDMONT PKWY
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NC
Practice Address - Zip Code:27282-7505
Practice Address - Country:US
Practice Address - Phone:336-852-9124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist