Provider Demographics
NPI:1609131283
Name:HEALTHWISE PHARMACY OF GREENVILLE INC
Entity Type:Organization
Organization Name:HEALTHWISE PHARMACY OF GREENVILLE INC
Other - Org Name:HOOKERTON FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATION SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MARCIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-752-0338
Mailing Address - Street 1:516-B SOUTH WILLIAM HOOKER DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOOKERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28538
Mailing Address - Country:US
Mailing Address - Phone:252-747-0154
Mailing Address - Fax:252-747-0153
Practice Address - Street 1:516 S WM HOOKER DR APT B
Practice Address - Street 2:
Practice Address - City:HOOKERTON
Practice Address - State:NC
Practice Address - Zip Code:28538-7188
Practice Address - Country:US
Practice Address - Phone:252-747-0154
Practice Address - Fax:252-747-0153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC113093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3460348OtherNCPDP PROVIDER IDENTIFICATION NUMBER