Provider Demographics
NPI:1639535156
Name:FIVE POINTS PHARMA
Entity Type:Organization
Organization Name:FIVE POINTS PHARMA
Other - Org Name:MEDICAL VILLAGEPHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-322-4505
Mailing Address - Street 1:815 FAIRGROVE CHURCH RD SE
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-8609
Mailing Address - Country:US
Mailing Address - Phone:828-322-4505
Mailing Address - Fax:828-322-2669
Practice Address - Street 1:815 FAIRGROVE CHURCH RD SE
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-8609
Practice Address - Country:US
Practice Address - Phone:828-322-4505
Practice Address - Fax:828-322-2669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC129093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1639535156Medicaid
2158134OtherPK
NC7559010001Medicare NSC