Provider Demographics
NPI:1497839393
Name:HAVELOCK DRUG COMPANY INC
Entity Type:Organization
Organization Name:HAVELOCK DRUG COMPANY INC
Other - Org Name:HAVELOCK DRUG COMPANY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MALISHEWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:BS RPH
Authorized Official - Phone:252-444-0910
Mailing Address - Street 1:1204 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAVELOCK
Mailing Address - State:NC
Mailing Address - Zip Code:28532-2405
Mailing Address - Country:US
Mailing Address - Phone:252-444-0910
Mailing Address - Fax:252-444-0721
Practice Address - Street 1:1204 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28532-2405
Practice Address - Country:US
Practice Address - Phone:252-444-0910
Practice Address - Fax:252-444-0721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NC094163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2066108OtherPK
NC0255710Medicaid
2066108OtherPK