Provider Demographics
NPI:1609958362
Name:CAROLINA RESPICARE PHARMACY,INC
Entity Type:Organization
Organization Name:CAROLINA RESPICARE PHARMACY,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-272-0044
Mailing Address - Street 1:4701 FAYETTEVILLE RD STE A
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2622
Mailing Address - Country:US
Mailing Address - Phone:910-272-0044
Mailing Address - Fax:910-272-0045
Practice Address - Street 1:4701 FAYETTEVILLE RD STE A
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2622
Practice Address - Country:US
Practice Address - Phone:910-272-0044
Practice Address - Fax:910-272-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00693332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2745Medicaid
NC7703196Medicaid
SCDE2745Medicaid