Provider Demographics
NPI:1568795516
Name:PHYSICIANS PHARMACY ALLIANCE
Entity Type:Organization
Organization Name:PHYSICIANS PHARMACY ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF PHARMACY OPERATIO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SHANNON
Authorized Official - Last Name:RAWLS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:919-463-5555
Mailing Address - Street 1:118 MACKENAN DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-9928
Mailing Address - Country:US
Mailing Address - Phone:919-463-5555
Mailing Address - Fax:919-463-5566
Practice Address - Street 1:118 MACKENAN DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-3624
Practice Address - Country:US
Practice Address - Phone:919-463-5555
Practice Address - Fax:919-463-5566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC08177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0920416Medicaid
3440461OtherNCPDP