Provider Demographics
NPI:1437256377
Name:NEW TOWN CENTER PHARMACY INC
Entity Type:Organization
Organization Name:NEW TOWN CENTER PHARMACY INC
Other - Org Name:TOWN CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMBASIVA
Authorized Official - Middle Name:R
Authorized Official - Last Name:VENIGALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-541-8126
Mailing Address - Street 1:610 S BENNETT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-5920
Mailing Address - Country:US
Mailing Address - Phone:910-692-7158
Mailing Address - Fax:910-692-0748
Practice Address - Street 1:610 S BENNETT ST
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-5920
Practice Address - Country:US
Practice Address - Phone:910-692-7158
Practice Address - Fax:910-692-0748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3411129OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3411129OtherOTHER ID NUMBER
NC0635409Medicaid
NC0635409Medicaid