Provider Demographics
NPI:1639535248
Name:ASHEVILLE BUNCOMBE COMMUNITY PHARMACY LLC
Entity Type:Organization
Organization Name:ASHEVILLE BUNCOMBE COMMUNITY PHARMACY LLC
Other - Org Name:ASHEVILLE BUNCOMBE COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-398-0123
Mailing Address - Street 1:356 BILTMORE AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4504
Mailing Address - Country:US
Mailing Address - Phone:828-398-0123
Mailing Address - Fax:
Practice Address - Street 1:356 BILTMORE AVE STE 209
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4504
Practice Address - Country:US
Practice Address - Phone:828-398-0123
Practice Address - Fax:828-412-4260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC128723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1639535248Medicaid
2158090OtherPK