Provider Demographics
NPI:1164729950
Name:QUAIL CORNERS PHARMACY LLC
Entity Type:Organization
Organization Name:QUAIL CORNERS PHARMACY LLC
Other - Org Name:QUAIL CORNERS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DUAH-MENSAH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:919-876-5020
Mailing Address - Street 1:5039 FALLS OF NEUSE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-5462
Mailing Address - Country:US
Mailing Address - Phone:919-876-5020
Mailing Address - Fax:919-876-5494
Practice Address - Street 1:5039 FALLS OF NEUSE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5462
Practice Address - Country:US
Practice Address - Phone:919-876-5020
Practice Address - Fax:919-876-5494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC109373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3458418OtherNCPDP PROVIDER ID