Provider Demographics
NPI:1538145610
Name:FAMILY PHARMACY OF STATESVILLE, INC.
Entity Type:Organization
Organization Name:FAMILY PHARMACY OF STATESVILLE, INC.
Other - Org Name:FAMILY PHARMACY OF STATESVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:EUDY
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:704-872-0296
Mailing Address - Street 1:3478 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-4523
Mailing Address - Country:US
Mailing Address - Phone:704-872-0296
Mailing Address - Fax:704-883-5856
Practice Address - Street 1:3478 E BROAD ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-4523
Practice Address - Country:US
Practice Address - Phone:704-872-0296
Practice Address - Fax:704-883-5856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X, 333600000X, 3336C0004X, 3336H0001X, 3336H0001X
NC043833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2069161OtherPK
NC0495390Medicaid
NC0495390Medicaid
VA0214001850OtherPHARMACY PERMIT