Provider Demographics
NPI:1265460901
Name:A1 PHARMACY AND SURGICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:A1 PHARMACY AND SURGICAL SUPPLY, LLC
Other - Org Name:A1 PHARMACY AND SURGICAL SUPPLY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MS RPH
Authorized Official - Phone:980-328-4476
Mailing Address - Street 1:124 FOREST HILL RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-2008
Mailing Address - Country:US
Mailing Address - Phone:336-224-6500
Mailing Address - Fax:336-224-6555
Practice Address - Street 1:124 FOREST HILL RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295
Practice Address - Country:US
Practice Address - Phone:336-224-6500
Practice Address - Fax:336-224-6555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X, 332BC3200X, 333600000X
NC093173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No291U00000XLaboratoriesClinical Medical Laboratory
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2065853OtherPK
NC0295864Medicaid
5760110001Medicare NSC