Provider Demographics
NPI:1427155365
Name:FAMILY PHARMACY INC
Entity type:Organization
Organization Name:FAMILY PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MNGR
Authorized Official - Prefix:
Authorized Official - First Name:ROYAL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:910-371-3181
Mailing Address - Street 1:112G VILLAGE RD NE
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-7412
Mailing Address - Country:US
Mailing Address - Phone:910-371-3181
Mailing Address - Fax:710-371-1775
Practice Address - Street 1:112G VILLAGE RD NE
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-7412
Practice Address - Country:US
Practice Address - Phone:910-371-3181
Practice Address - Fax:710-371-1775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC101613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0105320Medicaid
2072356OtherPK
1264060001Medicare NSC