Provider Demographics
NPI:1700024528
Name:CARLIES CS OF BENSON INC
Entity Type:Organization
Organization Name:CARLIES CS OF BENSON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FAIRCLOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-892-4124
Mailing Address - Street 1:604 S WALL ST
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-1824
Mailing Address - Country:US
Mailing Address - Phone:919-894-1237
Mailing Address - Fax:919-894-1343
Practice Address - Street 1:604 S WALL ST
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-1824
Practice Address - Country:US
Practice Address - Phone:919-894-1237
Practice Address - Fax:919-894-1343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10233OtherSTATE LICENSE/PERMIT