Provider Demographics
NPI:1598858920
Name:MIDTOWN PHARMACY LLC
Entity Type:Organization
Organization Name:MIDTOWN PHARMACY LLC
Other - Org Name:MIDTOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:COCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:336-446-0099
Mailing Address - Street 1:941 CENTER CREST DR STE A
Mailing Address - Street 2:
Mailing Address - City:WHITSETT
Mailing Address - State:NC
Mailing Address - Zip Code:27377-8002
Mailing Address - Country:US
Mailing Address - Phone:336-446-0099
Mailing Address - Fax:336-446-0094
Practice Address - Street 1:941 CENTER CREST DR STE A
Practice Address - Street 2:
Practice Address - City:WHITSETT
Practice Address - State:NC
Practice Address - Zip Code:27377
Practice Address - Country:US
Practice Address - Phone:336-446-0099
Practice Address - Fax:336-446-0094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC083353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0418081Medicaid
2069940OtherPK