Provider Demographics
NPI:1043204902
Name:COMMUNITY FAMILY PHARMACY
Entity Type:Organization
Organization Name:COMMUNITY FAMILY PHARMACY
Other - Org Name:SHELBY FAMILY PHARMACY INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-300-7197
Mailing Address - Street 1:1194 WYKE RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-4259
Mailing Address - Country:US
Mailing Address - Phone:704-482-4457
Mailing Address - Fax:704-487-5427
Practice Address - Street 1:1194 WYKE RD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-4259
Practice Address - Country:US
Practice Address - Phone:704-482-4457
Practice Address - Fax:704-487-5427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC082000183500000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0235499Medicaid
NC7700402Medicaid
NC7700402Medicaid