Midelu Incorporated

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

10031 Issued in NC

Legal business name

MIDELU INCORPORATED

Doing business as

Pleasant Garden Drug Store

Practice address

4822 Pleasant Garden Rd
Pleasant Garden, NC 27313-8253

Phone

(336) 674-5611

Fax

(336) 674-0995

NPI assigned

Jun 11, 2006

Last updated

Dec 8, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Griffin, PHARMD

Title

President

Phone

(336) 963-3317

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• PLEASANT GARDEN DRUG STORE Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Isaac Fred Brady III, RPH

  • Pharmacist
  • Pleasant Garden, NC
  • NPI 1275616799
  NPD (past)
• Michael Shaun Johnston, PHARM D

  • Pharmacist
  • Pleasant Garden, NC
  • NPI 1811224892
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481155200000",
    "number": "1902848500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2593 GREY RABBIT RUN",
            "city": "ASHEBORO",
            "state": "NC",
            "postal_code": "272058097",
            "telephone_number": "336-857-1997",
            "fax_number": "866-238-8879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4822 PLEASANT GARDEN RD",
            "city": "PLEASANT GARDEN",
            "state": "NC",
            "postal_code": "273138253",
            "telephone_number": "336-674-5611",
            "fax_number": "336-674-0995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDELU INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2016-12-08",
        "status": "A",
        "authorized_official_last_name": "GRIFFIN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-963-3317",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "10031",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0415281",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2066637",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PLEASANT GARDEN DRUG STORE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Donald Eric Kropski, COTA/L
• Londry & Modlin XV DDS PLLC (Pleasant Garden Dental)
• Sybil Lucas, PTA
• Nicholas Thomas Aivars Lukasevics, PTA
• Karen Meadows, LCMHCA
• Katiuska Duarte Morgan
• Anya Murphy-Parker, LCSWA
• Neighborhood Home Care, LLC
• Renee Otte
• Katie Pittman

• Community/Retail Pharmacy in Pleasant Garden, NC
• Providers in Pleasant Garden, NC by specialty
• Community/Retail Pharmacy in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.