1750486494 NPI number — SNEADS FERRY FAMILY PHARMACY INC

Table of content: (NPI 1750486494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750486494 NPI number — SNEADS FERRY FAMILY PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SNEADS FERRY FAMILY PHARMACY 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:
SNEADS FERRY FAMILY 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:
1750486494
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1016 OLD FOLKSTONE RD STE 214
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SNEADS FERRY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28460-9414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-327-2454
Provider Business Mailing Address Fax Number:
910-327-2543

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1016 OLD FOLKSTONE RD STE 214
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SNEADS FERRY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28460-9414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-327-2454
Provider Business Practice Location Address Fax Number:
910-327-2543
Provider Enumeration Date:
09/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CUTLER
Authorized Official First Name:
SABRINA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHCY MGR
Authorized Official Telephone Number:
910-327-2454

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: 09236 , 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: 3405253 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0675652 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".