Provider Demographics
NPI:1457090888
Name:FUQUAY PHARMACY LLC
Entity Type:Organization
Organization Name:FUQUAY PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:HANNA MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABANTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-557-8300
Mailing Address - Street 1:305 N JUDD PKWY NE
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-2370
Mailing Address - Country:US
Mailing Address - Phone:919-557-8300
Mailing Address - Fax:
Practice Address - Street 1:305 N JUDD PKWY NE
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2370
Practice Address - Country:US
Practice Address - Phone:919-557-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-02
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy