Provider Demographics
NPI:1659798361
Name:BLUE RIDGE PHARMACY INC
Entity Type:Organization
Organization Name:BLUE RIDGE PHARMACY INC
Other - Org Name:SONA PHARMACY PLUS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:828-298-3636
Mailing Address - Street 1:805 FAIRVIEW RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1011
Mailing Address - Country:US
Mailing Address - Phone:828-298-3636
Mailing Address - Fax:828-298-8190
Practice Address - Street 1:805 FAIRVIEW RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1011
Practice Address - Country:US
Practice Address - Phone:828-298-3636
Practice Address - Fax:828-298-8190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2016-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9136183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7N9143Medicaid
NC0116700Medicaid
NC5549310001Medicare NSC