Provider Demographics
NPI:1912682113
Name:PEMBROKE DRUG HOLDINGS, LLC
Entity type:Organization
Organization Name:PEMBROKE DRUG HOLDINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER-MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DEESE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:910-775-9209
Mailing Address - Street 1:205 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-8768
Mailing Address - Country:US
Mailing Address - Phone:910-775-9209
Mailing Address - Fax:910-775-9124
Practice Address - Street 1:205 W 3RD ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-8768
Practice Address - Country:US
Practice Address - Phone:910-775-9209
Practice Address - Fax:910-775-9124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-16
Last Update Date:2023-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy