Provider Demographics
NPI:1457794950
Name:TAR HEEL DRUG LTC, LLC
Entity type:Organization
Organization Name:TAR HEEL DRUG LTC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:DEMING
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:336-228-9003
Mailing Address - Street 1:316 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-3320
Mailing Address - Country:US
Mailing Address - Phone:336-228-9003
Mailing Address - Fax:336-227-7401
Practice Address - Street 1:316 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-3320
Practice Address - Country:US
Practice Address - Phone:336-228-9003
Practice Address - Fax:336-227-7401
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAR HEEL DRUG, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC115223336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11522OtherNCBOP PERMIT NUMBER