Provider Demographics
NPI:1598295784
Name:TARHEEL TOWN PHARMACY, LLC
Entity Type:Organization
Organization Name:TARHEEL TOWN PHARMACY, LLC
Other - Org Name:TARHEEL TOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALLESHAPPA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BABA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-240-7827
Mailing Address - Street 1:370 E MAIN ST STE 160
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-1866
Mailing Address - Country:US
Mailing Address - Phone:919-904-6474
Mailing Address - Fax:
Practice Address - Street 1:370 E MAIN ST STE 160
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-1866
Practice Address - Country:US
Practice Address - Phone:919-904-6474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC132763336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy