Provider Demographics
NPI:1972940377
Name:CAPE FEAR LONG TERM CARE PHARMACY LLC
Entity type:Organization
Organization Name:CAPE FEAR LONG TERM CARE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFRIES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:910-893-2986
Mailing Address - Street 1:185 PINE STATE ST
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-9415
Mailing Address - Country:US
Mailing Address - Phone:910-893-2986
Mailing Address - Fax:866-375-9070
Practice Address - Street 1:185 PINE STATE ST
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-9415
Practice Address - Country:US
Practice Address - Phone:910-893-2986
Practice Address - Fax:866-375-9070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-28
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC115253336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2141105OtherPK