Provider Demographics
NPI:1427568427
Name:C3HEALTHCARERX LLC
Entity Type:Organization
Organization Name:C3HEALTHCARERX LLC
Other - Org Name:C3 HEALTHCARERX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:GANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-411-1520
Mailing Address - Street 1:909 AVIATION PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-6603
Mailing Address - Country:US
Mailing Address - Phone:919-341-3842
Mailing Address - Fax:919-813-2671
Practice Address - Street 1:909 AVIATION PKWY STE 400
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6603
Practice Address - Country:US
Practice Address - Phone:919-341-3832
Practice Address - Fax:919-813-2671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-04
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336L0003X
NY0359863336C0003X
NC133243336C0003X
OH0228806503336C0003X
FLPH311743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1427568427Medicaid
2171223OtherPK