Provider Demographics
NPI:1306270574
Name:TRIAD CHOICE PHARMACY
Entity type:Organization
Organization Name:TRIAD CHOICE PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:OKAFOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-893-6286
Mailing Address - Street 1:658 WAUGHTOWN ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-2217
Mailing Address - Country:US
Mailing Address - Phone:336-893-6286
Mailing Address - Fax:336-893-6288
Practice Address - Street 1:658 WAUGHTOWN ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-2217
Practice Address - Country:US
Practice Address - Phone:336-893-6286
Practice Address - Fax:336-893-6288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-23
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC116483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2142449OtherPK
NC6957550001Medicare NSC