Provider Demographics
NPI:1154475507
Name:ATLANTIC HLTH RESOURCES INC
Entity Type:Organization
Organization Name:ATLANTIC HLTH RESOURCES INC
Other - Org Name:ATLANTIC HLTH RESOURCES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:704-895-6527
Mailing Address - Street 1:PO BOX 1405
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-1405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:582 DAVIDSON GATEWAY DR
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-7009
Practice Address - Country:US
Practice Address - Phone:704-895-6527
Practice Address - Fax:704-892-6040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336H0001X
NC092633336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3407637OtherNCPDP PROVIDER IDENTIFICATION NUMBER