Provider Demographics
NPI:1477880185
Name:CARLIE CS OF CLIFFDALE LLC
Entity Type:Organization
Organization Name:CARLIE CS OF CLIFFDALE LLC
Other - Org Name:CARLIE C'S PHARMACY #830
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LIBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:910-826-8942
Mailing Address - Street 1:690 S REILLY RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-5626
Mailing Address - Country:US
Mailing Address - Phone:910-826-8942
Mailing Address - Fax:910-826-9069
Practice Address - Street 1:690 S REILLY RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-5626
Practice Address - Country:US
Practice Address - Phone:910-826-8942
Practice Address - Fax:910-826-9069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3418212OtherNCPDP PROVIDER IDENTIFICATION NUMBER