Provider Demographics
NPI:1538297106
Name:NEW HANOVERCOMMUNITY HEATH CENTER
Entity Type:Organization
Organization Name:NEW HANOVERCOMMUNITY HEATH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:IPOCK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:910-343-0270
Mailing Address - Street 1:925 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-3450
Mailing Address - Country:US
Mailing Address - Phone:910-343-0270
Mailing Address - Fax:910-251-1540
Practice Address - Street 1:925 N 4TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-3450
Practice Address - Country:US
Practice Address - Phone:910-343-0270
Practice Address - Fax:910-251-1540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9049183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3429948OtherNABP NUMBER
NC344555BMedicaid
NC34-1840Medicare ID - Type Unspecified