Active NPI
Milton McIntyre Fairly III, RPH
- Pharmacist
- Walkertown, NC
National Provider Identifier
1619262292
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 10473
- Practice address
- 5210 Reidsville Rd
Walkertown, NC 27051-9405 - Phone
- (336) 595-3640
- NPI assigned
- Jun 13, 2011
- Last updated
- Jun 13, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 10473 | NC | Primary |
Addresses
Primary practice location
5210 Reidsville Rd
Walkertown, NC 27051-9405
Mailing address
3945 Huttons Lake CT
High Point, NC 27265-1287
Phone (336) 454-7193
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Carolina CVS Pharmacy LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307923200000",
"number": "1619262292",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3945 HUTTONS LAKE CT",
"city": "HIGH POINT",
"state": "NC",
"postal_code": "272651287",
"telephone_number": "336-454-7193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5210 REIDSVILLE RD",
"city": "WALKERTOWN",
"state": "NC",
"postal_code": "270519405",
"telephone_number": "336-595-3640"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAIRLY",
"first_name": "MILTON",
"middle_name": "MCINTYRE",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-06-13",
"last_updated": "2011-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NC",
"license": "10473",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Walkertown, NC
- Lindsay Ann Cooper, PHARMD
- Leslie J Davis, NP
- Pamela Ingram Earnhardt, PHARM.D.
- Ed-Core, Inc (Triad Homes-NC)
- Eyecarecenter OD PA
- Forsyth Memorial Hospital, Inc (Novant Health Walkertown Family Medicine)
- William Brooks Fulp Jr., LMBT, MMP
- Jared Wyllys Harwood, PA-C
- David Randal Heath, DDS
- Kwone U Ingram, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.