Provider Demographics
NPI:1346417185
Name:CAROLINA PHARMACY SERVICES
Entity type:Organization
Organization Name:CAROLINA PHARMACY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:SCHOMBERG
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:336-677-5000
Mailing Address - Street 1:2560 INNISFAIL LN
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8693
Mailing Address - Country:US
Mailing Address - Phone:336-677-5000
Mailing Address - Fax:336-677-5010
Practice Address - Street 1:207A ASH ST
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-6869
Practice Address - Country:US
Practice Address - Phone:336-677-5000
Practice Address - Fax:336-677-5010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC090303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7704341Medicaid