Provider Demographics
NPI:1588705388
Name:NORTH CAROLINA SPECIALTY HOSPITAL PHARMACY DEPT.
Entity type:Organization
Organization Name:NORTH CAROLINA SPECIALTY HOSPITAL PHARMACY DEPT.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:WINSTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:919-956-9300
Mailing Address - Street 1:3916 BEN FRANKLIN BOULEVARD
Mailing Address - Street 2:PO BOX 15819
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-0819
Mailing Address - Country:US
Mailing Address - Phone:919-956-9300
Mailing Address - Fax:919-595-8467
Practice Address - Street 1:3916 BEN FRANKLIN BOULEVARD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-0819
Practice Address - Country:US
Practice Address - Phone:919-956-9300
Practice Address - Fax:919-595-8467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07837333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0326544Medicaid