Provider Demographics
NPI:1134480718
Name:COUNTY OF CUMBERLAND OFFICE OF TREASURER
Entity Type:Organization
Organization Name:COUNTY OF CUMBERLAND OFFICE OF TREASURER
Other - Org Name:CUMBERLAND COUNTY EMPLOYEE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:KEIBLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-433-3897
Mailing Address - Street 1:227 FOUNTAINHEAD LN
Mailing Address - Street 2:SUITE #104
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-5488
Mailing Address - Country:US
Mailing Address - Phone:910-433-3861
Mailing Address - Fax:910-433-3869
Practice Address - Street 1:227 FOUNTAINHEAD LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5488
Practice Address - Country:US
Practice Address - Phone:910-433-3861
Practice Address - Fax:910-433-3869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC112913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2135892OtherPK