Provider Demographics
NPI:1932235199
Name:B&B ENTERPRISES OF FAY INC
Entity type:Organization
Organization Name:B&B ENTERPRISES OF FAY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:HALL
Authorized Official - Last Name:FONVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:910-486-5936
Mailing Address - Street 1:1431 RAMSEY ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-4405
Mailing Address - Country:US
Mailing Address - Phone:910-486-5936
Mailing Address - Fax:910-486-9227
Practice Address - Street 1:1431 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-4405
Practice Address - Country:US
Practice Address - Phone:910-486-5936
Practice Address - Fax:910-486-9227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332B00000X
NC56383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0265868Medicaid
NC3430585OtherNCPDP #
NC0409EOtherBCBS
NC7701392Medicaid
NCBM3991406OtherDEA #
NC2801143Medicare PIN
NC7701392Medicaid