Provider Demographics
NPI:1497912653
Name:THE C. W. WILLIAMS COMMUNITY HEALTH CENTER PHARMACY
Entity Type:Organization
Organization Name:THE C. W. WILLIAMS COMMUNITY HEALTH CENTER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:IRBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-393-7720
Mailing Address - Street 1:PO BOX 668093
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28266-8093
Mailing Address - Country:US
Mailing Address - Phone:704-393-7720
Mailing Address - Fax:704-391-0729
Practice Address - Street 1:3333 WILKINSON BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-5631
Practice Address - Country:US
Practice Address - Phone:704-393-7720
Practice Address - Fax:704-391-0729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC344507BMedicaid