Provider Demographics
NPI:1003262072
Name:HAW RIVER PHARMACY LLC
Entity Type:Organization
Organization Name:HAW RIVER PHARMACY LLC
Other - Org Name:HAW RIVER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:BHAGAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-383-9902
Mailing Address - Street 1:740 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAW RIVER
Mailing Address - State:NC
Mailing Address - Zip Code:27258-9644
Mailing Address - Country:US
Mailing Address - Phone:336-578-0202
Mailing Address - Fax:336-578-0266
Practice Address - Street 1:740 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HAW RIVER
Practice Address - State:NC
Practice Address - Zip Code:27258-9644
Practice Address - Country:US
Practice Address - Phone:336-578-0202
Practice Address - Fax:336-578-0266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-10
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC130173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160824OtherPK