Provider Demographics
NPI:1609024595
Name:GPN EXPRESS ENTERPRISE LLC
Entity Type:Organization
Organization Name:GPN EXPRESS ENTERPRISE LLC
Other - Org Name:VILLAGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NHAT QUY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRINH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-319-6050
Mailing Address - Street 1:14057 US HIGHWAY 17 N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-3770
Mailing Address - Country:US
Mailing Address - Phone:910-319-6050
Mailing Address - Fax:910-319-6045
Practice Address - Street 1:14057 US HIGHWAY 17 N
Practice Address - Street 2:SUITE 100
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-3770
Practice Address - Country:US
Practice Address - Phone:910-319-6050
Practice Address - Fax:910-319-6045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0003X, 3336C0004X
NC101513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00432780Medicaid
NC15085OtherPHARMACY PERMIT
2116749OtherPK