Provider Demographics
NPI:1275578700
Name:STEWART PHARMACEUTICALS INC
Entity Type:Organization
Organization Name:STEWART PHARMACEUTICALS INC
Other - Org Name:STEWART COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CHALMAS
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:910-483-5450
Mailing Address - Street 1:101 BROADFOOT AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5001
Mailing Address - Country:US
Mailing Address - Phone:910-483-5450
Mailing Address - Fax:910-483-6228
Practice Address - Street 1:101 BROADFOOT AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5001
Practice Address - Country:US
Practice Address - Phone:910-483-5450
Practice Address - Fax:910-483-6228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
NC053733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3426055OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NC7701130OtherMEDICAID DME
NC0265819Medicaid
NC7701130OtherMEDICAID DME