Provider Demographics
NPI:1285665521
Name:WAKEMED OP LLC
Entity Type:Organization
Organization Name:WAKEMED OP LLC
Other - Org Name:WAKEMED OUTPATIENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE, INTERIM CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:SESSOMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-350-0527
Mailing Address - Street 1:3000 NEW BERN AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1231
Mailing Address - Country:US
Mailing Address - Phone:919-350-8195
Mailing Address - Fax:919-350-7007
Practice Address - Street 1:3000 NEW BERN AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1231
Practice Address - Country:US
Practice Address - Phone:919-350-8195
Practice Address - Fax:919-350-7007
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAKEMED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-05
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336I0012X
NC031403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2070388OtherPK
NC0925263Medicaid