Provider Demographics
NPI:1376579052
Name:CHS PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:CHS PHARMACY SERVICES INC
Other - Org Name:ATRIUM HEALTH PHARMACY PAVILION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AVP PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:COLE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-446-1404
Mailing Address - Street 1:PO BOX 603216
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3216
Mailing Address - Country:US
Mailing Address - Phone:704-512-7637
Mailing Address - Fax:704-512-7630
Practice Address - Street 1:920 CHURCH ST N
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025
Practice Address - Country:US
Practice Address - Phone:704-403-1568
Practice Address - Fax:704-403-1784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
NC129843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0135699Medicaid
2069332OtherPK
7407820002Medicare NSC