Provider Demographics
NPI:1033203443
Name:R H MAC INC
Entity Type:Organization
Organization Name:R H MAC INC
Other - Org Name:DOWN EAST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-672-4440
Mailing Address - Street 1:1904 MARTIN LUTHER KING BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-4542
Mailing Address - Country:US
Mailing Address - Phone:252-672-4440
Mailing Address - Fax:252-672-4445
Practice Address - Street 1:1904 MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-4542
Practice Address - Country:US
Practice Address - Phone:252-672-4440
Practice Address - Fax:252-672-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC084423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0255661Medicaid
2068664OtherPK
NC7703962Medicaid
NC0255661Medicaid
NCBM8708692OtherDEA #