Provider Demographics
NPI:1508959933
Name:MICROPHARM INC
Entity Type:Organization
Organization Name:MICROPHARM INC
Other - Org Name:CRAMERTON DRUG COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GUY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-824-4401
Mailing Address - Street 1:149 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:CRAMERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28032-1401
Mailing Address - Country:US
Mailing Address - Phone:704-824-4401
Mailing Address - Fax:704-824-7882
Practice Address - Street 1:149 8TH AVE
Practice Address - Street 2:
Practice Address - City:CRAMERTON
Practice Address - State:NC
Practice Address - Zip Code:28032-1401
Practice Address - Country:US
Practice Address - Phone:704-824-4401
Practice Address - Fax:704-824-7882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC044723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0365684Medicaid
2065736OtherPK
270665Medicare ID - Type Unspecified
NC2800134Medicare PIN