Provider Demographics
NPI:1285883207
Name:HEALTHFIRST PHARMACY OF WAKE FOREST,LLC
Entity type:Organization
Organization Name:HEALTHFIRST PHARMACY OF WAKE FOREST,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:919-569-0500
Mailing Address - Street 1:2001 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-1612
Mailing Address - Country:US
Mailing Address - Phone:919-569-0500
Mailing Address - Fax:919-556-4288
Practice Address - Street 1:2001 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-1612
Practice Address - Country:US
Practice Address - Phone:919-569-0500
Practice Address - Fax:919-556-4288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC08879333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0920745Medicaid
NC7704226Medicaid
NC2801166OtherMEDICARE PROVIDER
NC0920745Medicaid