Provider Demographics
NPI:1528060852
Name:MEDICAL ARTS PHARMACY OF CUMBERLAND COUNTY
Entity type:Organization
Organization Name:MEDICAL ARTS PHARMACY OF CUMBERLAND COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:H
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:910-323-9696
Mailing Address - Street 1:1047 MURCHISON RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-7028
Mailing Address - Country:US
Mailing Address - Phone:910-323-9696
Mailing Address - Fax:910-323-9966
Practice Address - Street 1:1047 MURCHISON RD
Practice Address - Street 2:SUITE 106
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-7028
Practice Address - Country:US
Practice Address - Phone:910-323-9696
Practice Address - Fax:910-323-9966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5515333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0265843Medicaid
NC7701211Medicaid
NC0438KOtherBLUE CROSS SUPPLIER
NC0265843Medicaid
NC2800976Medicare PIN
NC0265843Medicaid