1750890109 NPI number — CARTER'S FAMILY PHARMACY LLC

Table of content: (NPI 1750890109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750890109 NPI number — CARTER'S FAMILY PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARTER'S FAMILY 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:
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:
1750890109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 N FAYETTEVILLE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHEBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27203-4611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-625-8650
Provider Business Mailing Address Fax Number:
336-636-5920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 N FAYETTEVILLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHEBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27203-4611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-625-8650
Provider Business Practice Location Address Fax Number:
336-636-5920
Provider Enumeration Date:
09/28/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HURLEY
Authorized Official First Name:
BRANDON
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
336-625-8650

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  13334 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X , with the licence number: 13334 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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