Provider Demographics
NPI:1528097441
Name:MACK'S 1ST RX PHARMACY INC
Entity type:Organization
Organization Name:MACK'S 1ST RX PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:N
Authorized Official - Last Name:MARLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-872-0880
Mailing Address - Street 1:837 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3222
Mailing Address - Country:US
Mailing Address - Phone:704-872-0880
Mailing Address - Fax:704-871-0440
Practice Address - Street 1:8782 NC HWY 90 E
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NC
Practice Address - Zip Code:28678
Practice Address - Country:US
Practice Address - Phone:704-585-2102
Practice Address - Fax:704-585-9440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC59953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0025148Medicaid