Provider Demographics
NPI:1356504542
Name:AVACARE INC
Entity Type:Organization
Organization Name:AVACARE INC
Other - Org Name:AVACARE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMMI
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:336-294-1044
Mailing Address - Street 1:7355 W FRIENDLY AVE
Mailing Address - Street 2:STE E
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-6373
Mailing Address - Country:US
Mailing Address - Phone:336-294-1044
Mailing Address - Fax:336-294-5661
Practice Address - Street 1:7355 W FRIENDLY AVE
Practice Address - Street 2:STE E
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-6373
Practice Address - Country:US
Practice Address - Phone:336-294-1044
Practice Address - Fax:336-294-5661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC101013336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2067395OtherPK