Provider Demographics
NPI:1154040251
Name:ROWLAND OLD MAIN, INC.
Entity type:Organization
Organization Name:ROWLAND OLD MAIN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKLEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-521-5600
Mailing Address - Street 1:PO BOX 2639
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-2639
Mailing Address - Country:US
Mailing Address - Phone:105-215-6009
Mailing Address - Fax:910-521-1906
Practice Address - Street 1:407 W 3RD ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-7977
Practice Address - Country:US
Practice Address - Phone:105-215-6009
Practice Address - Fax:910-521-1906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy