Provider Demographics
NPI:1629175567
Name:COMMUNITY PHARMACY OF ALBEMARLE LLC
Entity Type:Organization
Organization Name:COMMUNITY PHARMACY OF ALBEMARLE LLC
Other - Org Name:MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-904-3287
Mailing Address - Street 1:320 YADKIN ST
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-3447
Mailing Address - Country:US
Mailing Address - Phone:704-982-9179
Mailing Address - Fax:704-983-5557
Practice Address - Street 1:320 YADKIN ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3447
Practice Address - Country:US
Practice Address - Phone:704-982-9179
Practice Address - Fax:704-983-5557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12563333600000X
NC023973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151740OtherPK
0436970001Medicare NSC
NC0845149Medicaid