Provider Demographics
NPI:1427081439
Name:COOR'S PHARMACY, INC
Entity type:Organization
Organization Name:COOR'S PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:P
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:919-735-0400
Mailing Address - Street 1:1103 WAYNE MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-2957
Mailing Address - Country:US
Mailing Address - Phone:919-735-0400
Mailing Address - Fax:919-735-3530
Practice Address - Street 1:1103 WAYNE MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-2957
Practice Address - Country:US
Practice Address - Phone:919-735-0400
Practice Address - Fax:919-735-3530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09270332B00000X, 332BP3500X, 3336C0003X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0965733Medicaid
NC3429289OtherNABP
NC7704425Medicaid
NC03900OtherBCBS PROVIDER NUMBER
NC7704425Medicaid