Provider Demographics
NPI:1407057706
Name:PHARMACY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:PHARMACY ASSOCIATES, LLC
Other - Org Name:CAROLINA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER - MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:336-653-4068
Mailing Address - Street 1:534 GREENSBORO ST
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-4737
Mailing Address - Country:US
Mailing Address - Phone:336-625-6146
Mailing Address - Fax:336-625-3823
Practice Address - Street 1:534 GREENSBORO ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-4737
Practice Address - Country:US
Practice Address - Phone:336-625-6146
Practice Address - Fax:336-625-3823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC095083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3408514OtherNCPDP NUMBER
3408514OtherNCPDP NUMBER