Provider Demographics
NPI:1033228911
Name:MEDICAL CENTER PHARMACY INC OF HICKORY
Entity Type:Organization
Organization Name:MEDICAL CENTER PHARMACY INC OF HICKORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BASTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-322-7717
Mailing Address - Street 1:PO BOX 1627
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-1627
Mailing Address - Country:US
Mailing Address - Phone:828-322-7717
Mailing Address - Fax:828-322-3803
Practice Address - Street 1:126 N CENTER ST
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-6215
Practice Address - Country:US
Practice Address - Phone:822-322-7717
Practice Address - Fax:828-322-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01284332B00000X, 332BC3200X, 332BD1200X, 332BP3500X, 333600000X, 3336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0153720001Medicare NSC