Provider Demographics
NPI:1518364488
Name:CHURCH, DAVID J
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:CHURCH
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 1:16306 NICODEMUS LN
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078
Mailing Address - Country:US
Mailing Address - Phone:678-237-7344
Mailing Address - Fax:
Practice Address - Street 1:559 RIVER HWY
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8315
Practice Address - Country:US
Practice Address - Phone:704-663-3438
Practice Address - Fax:704-663-6469
Is Sole Proprietor?:No
Enumeration Date:2014-11-20
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202213622183500000X
NC28567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist