Provider Demographics
NPI:1689689200
Name:CAROLINA COMPOUNDING PHARMACY & HEALTH CENTER INC
Entity Type:Organization
Organization Name:CAROLINA COMPOUNDING PHARMACY & HEALTH CENTER INC
Other - Org Name:CAROLINA COMPOUNDING PHARMACY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKHTEYAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, RPH
Authorized Official - Phone:919-467-7110
Mailing Address - Street 1:254 TOWNE VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8910
Mailing Address - Country:US
Mailing Address - Phone:919-467-7110
Mailing Address - Fax:919-467-7976
Practice Address - Street 1:254 TOWNE VILLAGE DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8910
Practice Address - Country:US
Practice Address - Phone:919-467-7110
Practice Address - Fax:919-467-7976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
NC092073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2065763OtherPK