Provider Demographics
NPI:1083470520
Name:TWO RIVERS PHARMACY INC
Entity Type:Organization
Organization Name:TWO RIVERS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DEESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-748-0243
Mailing Address - Street 1:101 BROADFOOT AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5001
Mailing Address - Country:US
Mailing Address - Phone:910-748-0243
Mailing Address - Fax:910-748-0245
Practice Address - Street 1:101 BROADFOOT AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5001
Practice Address - Country:US
Practice Address - Phone:910-748-0243
Practice Address - Fax:910-748-0245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-22
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy