Provider Demographics
NPI:1073178265
Name:APPALACHIAN APOTHECARY INC
Entity Type:Organization
Organization Name:APPALACHIAN APOTHECARY INC
Other - Org Name:KIM'S PHARMACY LTC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-452-2313
Mailing Address - Street 1:479 DELLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-2907
Mailing Address - Country:US
Mailing Address - Phone:828-452-2313
Mailing Address - Fax:
Practice Address - Street 1:479 DELLWOOD RD
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-2907
Practice Address - Country:US
Practice Address - Phone:828-452-2313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APPALACHIAN APOTHECARY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-03
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0445828Medicaid