Provider Demographics
NPI:1619163375
Name:CHS PHARMACY SERVICES, INC.
Entity Type:Organization
Organization Name:CHS PHARMACY SERVICES, INC.
Other - Org Name:ATRIUM HEALTH PHARMACY SOUTHPARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AVP PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:COLE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-512-7628
Mailing Address - Street 1:PO BOX 603216
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3216
Mailing Address - Country:US
Mailing Address - Phone:704-512-7637
Mailing Address - Fax:704-512-7630
Practice Address - Street 1:4525 CAMERON VALLEY PKWY STE 1200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-4371
Practice Address - Country:US
Practice Address - Phone:704-512-6040
Practice Address - Fax:704-512-6041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC132653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0602128Medicaid
2066537OtherPK
NCFC6878980OtherDEA
NC0602128Medicaid