Provider Demographics
NPI:1245215771
Name:ALPHA PHARMACY/DBA DR PHARMACY OF NC
Entity Type:Organization
Organization Name:ALPHA PHARMACY/DBA DR PHARMACY OF NC
Other - Org Name:DR PHARMACY OF NC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:VETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-751-4288
Mailing Address - Street 1:959 SALISBURY RD
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-9301
Mailing Address - Country:US
Mailing Address - Phone:336-751-4288
Mailing Address - Fax:336-751-4688
Practice Address - Street 1:82 SPRUCE ST
Practice Address - Street 2:BUSINESS CNTR SUITE 101
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2150
Practice Address - Country:US
Practice Address - Phone:800-779-4550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP06958333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1027550001Medicare ID - Type Unspecified