Provider Demographics
NPI:1285676882
Name:ELLERBE PHARMACY
Entity Type:Organization
Organization Name:ELLERBE PHARMACY
Other - Org Name:ELLERBE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCASKILL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:910-652-6261
Mailing Address - Street 1:PO BOX 467
Mailing Address - Street 2:
Mailing Address - City:ELLERBE
Mailing Address - State:NC
Mailing Address - Zip Code:28338-0467
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:274 SECOND STREET
Practice Address - Street 2:
Practice Address - City:ELLERBE
Practice Address - State:NC
Practice Address - Zip Code:28338
Practice Address - Country:US
Practice Address - Phone:910-652-6261
Practice Address - Fax:910-652-2469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
NC118463336C0003X
NC02728332BP3500X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0775130Medicaid
2065844OtherPK
NC0387AOtherBLUE CROSS BLUE SHIELD
3405912OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NC7701176Medicaid