Provider Demographics
NPI:1679633812
Name:CENTER PHARMACY OF MAIDEN INC
Entity Type:Organization
Organization Name:CENTER PHARMACY OF MAIDEN INC
Other - Org Name:TAS DRUG MAIDEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARM
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:STAMEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:828-428-0668
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:MAIDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28650-0123
Mailing Address - Country:US
Mailing Address - Phone:828-428-0668
Mailing Address - Fax:828-428-3303
Practice Address - Street 1:201 ISLAND FORD RD STE D
Practice Address - Street 2:
Practice Address - City:MAIDEN
Practice Address - State:NC
Practice Address - Zip Code:28650-8733
Practice Address - Country:US
Practice Address - Phone:828-428-0668
Practice Address - Fax:828-428-3303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC052343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2070108OtherPK
NC0185769Medicaid
NC7700527Medicaid
NC0185769Medicaid