1821157827 NPI number — MCCARTHY SQUARE PHARMACY LLC

Table of content: (NPI 1821157827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821157827 NPI number — MCCARTHY SQUARE PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCCARTHY SQUARE PHARMACY LLC
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:
MCCARTHY SQUARE 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:
1821157827
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
609 MCCARTHY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BERN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28562-5232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-514-2900
Provider Business Mailing Address Fax Number:
252-514-2404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
609 MCCARTHY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BERN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28562-5232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-514-2900
Provider Business Practice Location Address Fax Number:
252-514-2404
Provider Enumeration Date:
12/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY MANAGER
Authorized Official Telephone Number:
252-514-2900

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 05941 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2070997 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0255588 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7701543 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".