1528060852 NPI number — MEDICAL ARTS PHARMACY OF CUMBERLAND COUNTY

Table of content: (NPI 1528060852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528060852 NPI number — MEDICAL ARTS PHARMACY OF CUMBERLAND COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL ARTS PHARMACY OF CUMBERLAND COUNTY
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:
6
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:
1528060852
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1047 MURCHISON RD
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28301-7028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-323-9696
Provider Business Mailing Address Fax Number:
910-323-9966

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1047 MURCHISON RD
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28301-7028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-323-9696
Provider Business Practice Location Address Fax Number:
910-323-9966
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WASHINGTON
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
910-323-9696

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  5515 , 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: 0265843 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7701211 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0438K . This is a "BLUE CROSS SUPPLIER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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