Provider Demographics
NPI:1083600696
Name:LAYNE'S FAMILY PHARMACY, INC.
Entity Type:Organization
Organization Name:LAYNE'S FAMILY PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:336-627-4600
Mailing Address - Street 1:509 S VAN BUREN RD
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-5018
Mailing Address - Country:US
Mailing Address - Phone:336-627-4600
Mailing Address - Fax:336-627-1399
Practice Address - Street 1:509 S VAN BUREN RD
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5018
Practice Address - Country:US
Practice Address - Phone:336-627-4600
Practice Address - Fax:336-627-1399
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAYNE'S FAMILY PHARMACY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-20
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07678332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0795759Medicaid
NC7703287Medicaid
VA9100865Medicaid