1710214754 NPI number — SHAR RICH, INC.

Table of content: MS. DOREEN CAROL BALERIA C.R.N.A. (NPI 1225011224)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710214754 NPI number — SHAR RICH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHAR RICH, 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:
TABLE ROCK PHARMACY
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:
1710214754
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 W FLEMING DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORGANTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28655-3918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-438-9355
Provider Business Mailing Address Fax Number:
828-433-1211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 W FLEMING DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28655-3918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-438-9355
Provider Business Practice Location Address Fax Number:
828-433-1211
Provider Enumeration Date:
11/12/2009

Additional Information

Authorized Official

Authorized Official Last Name:
OWENSBY
Authorized Official First Name:
SHARA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST/COOWNER
Authorized Official Telephone Number:
828-438-9355

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  5211 , 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: 0125401 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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