1922246818 NPI number — CALHOUN FAMILY PHARMACY INC

Table of content: (NPI 1922246818)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922246818 NPI number — CALHOUN FAMILY PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALHOUN 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:
DBA CAPE FEAR DISCOUNT DRUG NORTH
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:
1922246818
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2800 RAEFORD RD STE 18
Provider Second Line Business Mailing Address:
SUITE 18
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28303-5465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-977-3301
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4417 RAMSEY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-884-3053
Provider Business Practice Location Address Fax Number:
910-884-3061
Provider Enumeration Date:
01/30/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CALHOUN
Authorized Official First Name:
JEREMY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
910-263-0525

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  10195 , 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)





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