Provider Demographics
NPI:1265475560
Name:LAYNES FAMILY PHARMACY
Entity Type:Organization
Organization Name:LAYNES FAMILY PHARMACY
Other - Org Name:LAYNES FAMILY PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARM/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:336-627-4600
Mailing Address - Street 1:509 S VAN BUREN RD
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-5082
Mailing Address - Country:US
Mailing Address - Phone:336-627-4600
Mailing Address - Fax:336-627-1399
Practice Address - Street 1:509 S VAN BUREN RD
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5082
Practice Address - Country:US
Practice Address - Phone:336-627-4600
Practice Address - Fax:336-627-1399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NC076783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2068788OtherPK
NC0795759Medicaid
2068788OtherPK