Provider Demographics
NPI:1316232416
Name:HILLSBOROUGH PHARMACY & NUTRITION
Entity type:Organization
Organization Name:HILLSBOROUGH PHARMACY & NUTRITION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:919-245-1212
Mailing Address - Street 1:110 BOONE SQUARE ST STE 29
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-2665
Mailing Address - Country:US
Mailing Address - Phone:919-245-1212
Mailing Address - Fax:919-245-1210
Practice Address - Street 1:110 BOONE SQUARE ST STE 29
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-2665
Practice Address - Country:US
Practice Address - Phone:919-245-1212
Practice Address - Fax:919-245-1210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11064333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2134412OtherPK
NC7705429Medicaid
NC0685587Medicaid