Provider Demographics
NPI:1689048381
Name:SELECT CARE PHARMACY LLC
Entity Type:Organization
Organization Name:SELECT CARE PHARMACY LLC
Other - Org Name:SELECT CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-452-3891
Mailing Address - Street 1:15 GLENN BRIDGE RD STE A
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-8481
Mailing Address - Country:US
Mailing Address - Phone:828-585-2034
Mailing Address - Fax:855-782-5622
Practice Address - Street 1:15 GLENN BRIDGE RD STE A
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-8481
Practice Address - Country:US
Practice Address - Phone:828-585-2034
Practice Address - Fax:855-782-5622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC127463336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1689048381Medicaid
2155359OtherPK