Provider Demographics
NPI:1477860930
Name:FAMILY PHARMACY OF LOUISBURG, L.L.C.
Entity Type:Organization
Organization Name:FAMILY PHARMACY OF LOUISBURG, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST MANAGER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:PERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:919-340-1100
Mailing Address - Street 1:339 S BICKETT BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-2701
Mailing Address - Country:US
Mailing Address - Phone:919-340-1100
Mailing Address - Fax:919-340-1101
Practice Address - Street 1:339 S BICKETT BLVD
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2701
Practice Address - Country:US
Practice Address - Phone:919-340-1100
Practice Address - Fax:919-340-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-06
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0355321Medicaid
NC6484840001Medicare NSC