Provider Demographics
NPI:1104495522
Name:MOUNT GILEAD LLC
Entity type:Organization
Organization Name:MOUNT GILEAD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHINAPAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-439-6541
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27306-0248
Mailing Address - Country:US
Mailing Address - Phone:910-439-6541
Mailing Address - Fax:910-439-5723
Practice Address - Street 1:116 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:NC
Practice Address - Zip Code:27306-9254
Practice Address - Country:US
Practice Address - Phone:910-439-6541
Practice Address - Fax:910-439-5723
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNT GILEAD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy