Provider Demographics
NPI:1225121692
Name:FOOD LION LLC
Entity Type:Organization
Organization Name:FOOD LION LLC
Other - Org Name:FOOD LION PHARMACY #2580
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDNARZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-633-8250
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04104-5005
Mailing Address - Country:US
Mailing Address - Phone:207-885-3161
Mailing Address - Fax:207-885-3121
Practice Address - Street 1:301 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:NC
Practice Address - Zip Code:28551-1834
Practice Address - Country:US
Practice Address - Phone:252-566-9595
Practice Address - Fax:252-566-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8222332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0545590Medicaid
3440485OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NC0545590Medicaid