Provider Demographics
NPI:1194075945
Name:PHARAOHS PHARMACY INC
Entity type:Organization
Organization Name:PHARAOHS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:R.PH
Authorized Official - Prefix:
Authorized Official - First Name:ESLAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDEL MAGID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-681-1879
Mailing Address - Street 1:2971 CROUSE LN STE A
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8446
Mailing Address - Country:US
Mailing Address - Phone:336-270-3176
Mailing Address - Fax:
Practice Address - Street 1:2971 CROUSE LN STE A
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8446
Practice Address - Country:US
Practice Address - Phone:336-270-3176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC113293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3460475OtherNCPDP PROVIDER IDENTIFICATION NUMBER