Provider Demographics
NPI:1720044720
Name:PROFESSIONAL PHARMACY OF OXFORD LLC
Entity Type:Organization
Organization Name:PROFESSIONAL PHARMACY OF OXFORD LLC
Other - Org Name:PROFESSIONAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:DENNY
Authorized Official - Last Name:CLAIBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:919-693-8555
Mailing Address - Street 1:140 ROXBORO RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-2642
Mailing Address - Country:US
Mailing Address - Phone:919-693-8555
Mailing Address - Fax:919-603-0214
Practice Address - Street 1:140 ROXBORO RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-2642
Practice Address - Country:US
Practice Address - Phone:919-693-8555
Practice Address - Fax:919-603-0214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
NC100233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2070623OtherPK
NC0395450Medicaid
2070623OtherPK
NC7705003Medicaid