Provider Demographics
NPI:1104909142
Name:HAMPSTEAD FAMILY PHARMACY
Entity type:Organization
Organization Name:HAMPSTEAD FAMILY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHCY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-270-1077
Mailing Address - Street 1:15489 HWY 17 N
Mailing Address - Street 2:UNIT 2
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15489 HWY 17 N
Practice Address - Street 2:UNIT 2
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443
Practice Address - Country:US
Practice Address - Phone:910-270-1077
Practice Address - Fax:910-270-2711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
NC7703557332B00000X
NC08083333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08083OtherPHARMACY LIC
3438872OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NC0715242Medicaid
NC7703557Medicaid
0231960002Medicare ID - Type Unspecified