Provider Demographics
NPI:1992788020
Name:JA MCNEILL & SONS & DAUGHTER LLC
Entity type:Organization
Organization Name:JA MCNEILL & SONS & DAUGHTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCNEILL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:910-815-3122
Mailing Address - Street 1:PO BOX 2189
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-7189
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:712 TRAM RD
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3520
Practice Address - Country:US
Practice Address - Phone:910-642-0388
Practice Address - Fax:866-642-1152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC077113336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336L0003XSuppliersPharmacyLong Term Care PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0245794Medicaid
2072309OtherPK
2072309OtherPK