Provider Demographics
NPI:1588253470
Name:COMMUNITY CARE CLINIC OF ROWAN
Entity type:Organization
Organization Name:COMMUNITY CARE CLINIC OF ROWAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHAMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-636-4523
Mailing Address - Street 1:315 MOCKSVILLE AVE STE G
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-3346
Mailing Address - Country:US
Mailing Address - Phone:704-636-4523
Mailing Address - Fax:704-636-4529
Practice Address - Street 1:315 MOCKSVILLE AVE STE G
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-3346
Practice Address - Country:US
Practice Address - Phone:704-636-4523
Practice Address - Fax:704-636-4529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC06145OtherPHARMACY LIC