Provider Demographics
NPI:1962595397
Name:HICKORY FAMILY PHARMACY LLC.
Entity type:Organization
Organization Name:HICKORY FAMILY PHARMACY LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:BATSHON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:828-324-4630
Mailing Address - Street 1:1501 TATE BLVD SE
Mailing Address - Street 2:STE 102
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-1384
Mailing Address - Country:US
Mailing Address - Phone:828-324-4630
Mailing Address - Fax:828-324-4675
Practice Address - Street 1:1501 TATE BLVD SE
Practice Address - Street 2:STE 102
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1384
Practice Address - Country:US
Practice Address - Phone:828-324-4630
Practice Address - Fax:828-324-4675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC041833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7702037Medicaid
NC0185926Medicaid
2068862OtherPK
NC7702037Medicaid