Provider Demographics
NPI:1497904510
Name:DILLARD AND ASSOCIATES
Entity Type:Organization
Organization Name:DILLARD AND ASSOCIATES
Other - Org Name:MEDICAP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LUMBRAZO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:919-938-3800
Mailing Address - Street 1:70 CRAPE MYRTLE DR
Mailing Address - Street 2:STE 103
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-8034
Mailing Address - Country:US
Mailing Address - Phone:919-938-3800
Mailing Address - Fax:919-938-3801
Practice Address - Street 1:70 CRAPE MYRTLE DR
Practice Address - Street 2:STE 103
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-8034
Practice Address - Country:US
Practice Address - Phone:919-938-3800
Practice Address - Fax:919-938-3801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC078113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0435478Medicaid
NC4245350002Medicare NSC
NC0435478Medicaid