Provider Demographics
NPI:1659676948
Name:FUTRELL PHARMACY SERVICE INC
Entity Type:Organization
Organization Name:FUTRELL PHARMACY SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:FUTRELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:252-534-6001
Mailing Address - Street 1:PO BOX 768
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NC
Mailing Address - Zip Code:27845-0768
Mailing Address - Country:US
Mailing Address - Phone:252-534-6001
Mailing Address - Fax:252-534-1906
Practice Address - Street 1:9435 NC HIGHWAY 305
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NC
Practice Address - Zip Code:27845-9679
Practice Address - Country:US
Practice Address - Phone:252-534-6001
Practice Address - Fax:252-534-1906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC03288333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCPENDINGOtherCMS-855B PENDING
NC0463790001Medicare NSC