Provider Demographics
NPI:1124248331
Name:HARRISBURG PHARMACY SERVICES INC
Entity type:Organization
Organization Name:HARRISBURG PHARMACY SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:704-455-5355
Mailing Address - Street 1:4310 PHYSICIANS BLVD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075
Mailing Address - Country:US
Mailing Address - Phone:704-455-5355
Mailing Address - Fax:704-455-3323
Practice Address - Street 1:4310 PHYSICIANS BLVD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075
Practice Address - Country:US
Practice Address - Phone:704-455-5355
Practice Address - Fax:704-455-3323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC095293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0136018Medicaid
NC3408463OtherNCPDP #
NC7704698Medicaid
NCFH0222834OtherDEA #
NCFH0222834OtherDEA #
NC8012218Medicare PIN