Provider Demographics
NPI:1215932082
Name:CHAIR CITY PHARMACY INCORPORATED
Entity type:Organization
Organization Name:CHAIR CITY PHARMACY INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP AND SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:RUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-848-4439
Mailing Address - Street 1:C/O STEPHEN CARSWELL
Mailing Address - Street 2:109 FINBOROUGH CT.
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-8382
Mailing Address - Country:US
Mailing Address - Phone:336-848-4439
Mailing Address - Fax:
Practice Address - Street 1:916 RANDOLPH ST STE C
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-5729
Practice Address - Country:US
Practice Address - Phone:336-475-1888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC052683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0295550Medicaid
3427502OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NC0295550Medicaid