Provider Demographics
NPI:1073524633
Name:BARBOUR DRUGS INC
Entity Type:Organization
Organization Name:BARBOUR DRUGS INC
Other - Org Name:EDGEWOOD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:COCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-584-8878
Mailing Address - Street 1:2213 EDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-4547
Mailing Address - Country:US
Mailing Address - Phone:336-584-8878
Mailing Address - Fax:336-584-8816
Practice Address - Street 1:2213 EDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215
Practice Address - Country:US
Practice Address - Phone:336-584-8878
Practice Address - Fax:336-584-8816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NC135023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2065379OtherPK
NC0015859Medicaid
NC0015032Medicaid
1229700001Medicare NSC