Provider Demographics
NPI:1659356525
Name:BSE, INC
Entity Type:Organization
Organization Name:BSE, INC
Other - Org Name:THE MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-863-3949
Mailing Address - Street 1:PO BOX 508
Mailing Address - Street 2:
Mailing Address - City:BLADENBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28320-0508
Mailing Address - Country:US
Mailing Address - Phone:910-863-3949
Mailing Address - Fax:910-863-3940
Practice Address - Street 1:102 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:BLADENBORO
Practice Address - State:NC
Practice Address - Zip Code:28320-0508
Practice Address - Country:US
Practice Address - Phone:910-863-3949
Practice Address - Fax:910-863-3940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC04410183500000X, 332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0388BOtherBC BS PROVIDER NUMBER
NC7703225Medicaid
NC0095166Medicaid
NC3416282OtherNCPDP #
NC3416282OtherNCPDP #
NC0095166Medicaid
NC3416282OtherNCPDP #
NC20044WMedicare UPIN