Provider Demographics
NPI:1437536570
Name:MEDICAL PARK PHARMACY NEWPORT
Entity Type:Organization
Organization Name:MEDICAL PARK PHARMACY NEWPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:FLETCHER
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-726-0279
Mailing Address - Street 1:129 NINE FOOT RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-9251
Mailing Address - Country:US
Mailing Address - Phone:252-223-3080
Mailing Address - Fax:
Practice Address - Street 1:129 NINE FOOT RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-9251
Practice Address - Country:US
Practice Address - Phone:252-223-3080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC121561835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12156OtherNORTH CAROLINA BOARD OF PHARMACY