1245215771 NPI number — ALPHA PHARMACY/DBA DR PHARMACY OF NC

Table of content: (NPI 1245215771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245215771 NPI number — ALPHA PHARMACY/DBA DR PHARMACY OF NC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALPHA PHARMACY/DBA DR PHARMACY OF NC
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:
DR PHARMACY OF NC
Provider Other Organization Name Type Code:
4
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:
1245215771
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
959 SALISBURY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOCKSVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27028-9301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-751-4288
Provider Business Mailing Address Fax Number:
336-751-4688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
82 SPRUCE ST
Provider Second Line Business Practice Location Address:
BUSINESS CNTR SUITE 101
Provider Business Practice Location Address City Name:
MURRAY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42071-2150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-779-4550
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
VETTER
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
336-751-4288

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  P06958 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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