Provider Demographics
NPI:1639414915
Name:KINSTON CLINIC PHARMACY
Entity Type:Organization
Organization Name:KINSTON CLINIC PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:GRADY
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:252-523-3187
Mailing Address - Street 1:701 DOCTORS DR
Mailing Address - Street 2:SUITE P
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-1589
Mailing Address - Country:US
Mailing Address - Phone:252-523-3187
Mailing Address - Fax:252-522-2988
Practice Address - Street 1:701 DOCTORS DR
Practice Address - Street 2:SUITE P
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1589
Practice Address - Country:US
Practice Address - Phone:252-523-3187
Practice Address - Fax:252-522-2988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0545236Medicaid
NC0545236Medicaid