1629334354 NPI number — MEDICAL PHARMACY OF ALBEMARLE, INC.

Table of content: (NPI 1629334354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629334354 NPI number — MEDICAL PHARMACY OF ALBEMARLE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL PHARMACY OF ALBEMARLE, 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:
Provider Other Organization Name Type Code:
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:
1629334354
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 YADKIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBEMARLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28001-3447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-982-9179
Provider Business Mailing Address Fax Number:
704-983-5557

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 YADKIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBEMARLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28001-3447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-982-9179
Provider Business Practice Location Address Fax Number:
704-983-5557
Provider Enumeration Date:
04/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CASTELLOE
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
COLEMAN
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
704-982-9179

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: 2397 , 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: 0845149 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3403259 . This is a "NCPDP PROVIDER INDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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