Provider Demographics
NPI:1033215421
Name:786 PHARMACY INC
Entity Type:Organization
Organization Name:786 PHARMACY INC
Other - Org Name:TARHEEL DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MOAZZAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAIKH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-227-2093
Mailing Address - Street 1:316 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-3320
Mailing Address - Country:US
Mailing Address - Phone:336-227-2093
Mailing Address - Fax:336-227-7401
Practice Address - Street 1:316 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-3320
Practice Address - Country:US
Practice Address - Phone:336-227-2093
Practice Address - Fax:336-227-7401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC131983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2170335OtherPK
NC0015198Medicaid