Provider Demographics
NPI:1689188286
Name:JUSTICE PHARMACY,INC.
Entity Type:Organization
Organization Name:JUSTICE PHARMACY,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:JUSTICE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:910-755-6337
Mailing Address - Street 1:3288 CHANNEL SIDE DR SW
Mailing Address - Street 2:
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-2101
Mailing Address - Country:US
Mailing Address - Phone:910-842-8782
Mailing Address - Fax:
Practice Address - Street 1:301 S WILLIS DR
Practice Address - Street 2:#112
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470
Practice Address - Country:US
Practice Address - Phone:910-755-6337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-20
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8431333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy