Provider Demographics
NPI:1083351860
Name:BLUE RIDGE PHARMACY INC
Entity Type:Organization
Organization Name:BLUE RIDGE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:MATHENY
Authorized Official - Last Name:MICHAELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-298-3636
Mailing Address - Street 1:600 CAROLINA VILLAGE RD STE Z
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-1800
Mailing Address - Country:US
Mailing Address - Phone:828-233-0848
Mailing Address - Fax:
Practice Address - Street 1:600 CAROLINA VILLAGE RD STE Z
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-1800
Practice Address - Country:US
Practice Address - Phone:828-233-0848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy