Provider Demographics
NPI:1558671446
Name:PAMLICO PHARMACY INC
Entity Type:Organization
Organization Name:PAMLICO PHARMACY INC
Other - Org Name:PAMLICO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-626-4343
Mailing Address - Street 1:PO BOX 12426
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28561-2426
Mailing Address - Country:US
Mailing Address - Phone:252-745-6337
Mailing Address - Fax:252-745-5576
Practice Address - Street 1:11326 NC 55 HWY E
Practice Address - Street 2:
Practice Address - City:GRANTSBORO
Practice Address - State:NC
Practice Address - Zip Code:28529-9451
Practice Address - Country:US
Practice Address - Phone:252-745-6337
Practice Address - Fax:252-745-5576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
NC106383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2126457OtherPK