Provider Demographics
NPI:1497760011
Name:PITTMANS PHARMACY INC
Entity Type:Organization
Organization Name:PITTMANS PHARMACY INC
Other - Org Name:PITTMANS PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:252-794-3431
Mailing Address - Street 1:PO BOX 507
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:NC
Mailing Address - Zip Code:27983-0507
Mailing Address - Country:US
Mailing Address - Phone:252-794-3431
Mailing Address - Fax:
Practice Address - Street 1:305 W GRANVILLE ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NC
Practice Address - Zip Code:27983-1815
Practice Address - Country:US
Practice Address - Phone:252-794-3431
Practice Address - Fax:252-794-2896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NC037223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0085076Medicaid
2069342OtherPK
NC0085076Medicaid