Provider Demographics
NPI:1477898468
Name:RALEIGH NEUROLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:RALEIGH NEUROLOGY ASSOCIATES PA
Other - Org Name:RALEIGH NEUROLOGY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/PHCY OPS MGR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:919-325-4275
Mailing Address - Street 1:1540 SUNDAY DR
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6010
Mailing Address - Country:US
Mailing Address - Phone:919-325-4275
Mailing Address - Fax:919-325-4684
Practice Address - Street 1:1540 SUNDAY DR
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6010
Practice Address - Country:US
Practice Address - Phone:919-325-4275
Practice Address - Fax:919-325-4684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-03
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
NC114323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2138040OtherPK
NC0920775Medicaid