Provider Demographics
NPI:1215307103
Name:NEW ELLERBE PHARMACY INC
Entity type:Organization
Organization Name:NEW ELLERBE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KALPANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTTIPATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-652-6261
Mailing Address - Street 1:274 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:ELLERBE
Mailing Address - State:NC
Mailing Address - Zip Code:28338
Mailing Address - Country:US
Mailing Address - Phone:910-652-6261
Mailing Address - Fax:910-652-2469
Practice Address - Street 1:274 2ND STREET
Practice Address - Street 2:
Practice Address - City:ELLERBE
Practice Address - State:NC
Practice Address - Zip Code:28338
Practice Address - Country:US
Practice Address - Phone:910-652-6261
Practice Address - Fax:910-652-2469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No282E00000XHospitalsLong Term Care Hospital
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric