Provider Demographics
NPI:1487721510
Name:BADGER, JAMES MICHAEL (RPH)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:BADGER
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 1:203 WEST STREET
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640
Mailing Address - Country:US
Mailing Address - Phone:336-982-3080
Mailing Address - Fax:
Practice Address - Street 1:423 EAST 2ND STREET
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28694
Practice Address - Country:US
Practice Address - Phone:336-246-9990
Practice Address - Fax:336-246-6069
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC05609183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7701140OtherNC MED DME
NC0055004Medicaid
NC0159700001Medicare ID - Type Unspecified
3412107Medicare UPIN