1619060845 NPI number — FUTRELL PHARMACY SERVICE INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619060845 NPI number — FUTRELL PHARMACY SERVICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FUTRELL PHARMACY SERVICE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FUTRELL PHARMACY OF RICH SQUARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619060845
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 457
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICH SQUARE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27869-0457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-539-2552
Provider Business Mailing Address Fax Number:
252-539-4205

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
124 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICH SQUARE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27869
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-534-6001
Provider Business Practice Location Address Fax Number:
252-539-4205
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FUTRELL
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER AND PHARMACIST
Authorized Official Telephone Number:
252-534-6001

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 09355 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2065886 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0665117 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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