Provider Demographics
NPI:1184841280
Name:COMMUNITY PHARMACY OF LOCUST LLC.
Entity Type:Organization
Organization Name:COMMUNITY PHARMACY OF LOCUST LLC.
Other - Org Name:MEDICAL PHARMACY OF LOCUST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-904-3287
Mailing Address - Street 1:236 MARKET STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOCUST
Mailing Address - State:NC
Mailing Address - Zip Code:28097
Mailing Address - Country:US
Mailing Address - Phone:704-888-3784
Mailing Address - Fax:704-781-0026
Practice Address - Street 1:236 MARKET STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:LOCUST
Practice Address - State:NC
Practice Address - Zip Code:28097
Practice Address - Country:US
Practice Address - Phone:704-888-3784
Practice Address - Fax:704-781-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
NC094763336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2066164OtherPK
NC0845420Medicaid